Peretz, Anne Sofie Rosenborg; Madsen, Ole Rintek; Brogren, Elisabeth
Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery...
Brand, Leanne R; Munroe, Donna J; Gavin, Julie
Anxiety in patients awaiting surgery and diagnostic procedures in an ambulatory department can affect the patient's physiological and psychological well-being and outcome. We conducted a quasi-experimental study at a midwestern US community hospital to determine the effects of hand massage on patient anxiety in the ambulatory surgery setting. We also investigated whether adding the hand massage procedure affected the timing and flow of procedures. The results indicated that hand massage reduces anxiety for patients awaiting ambulatory surgery and outpatient procedures. Participants who received hand massage experienced lower anxiety levels than those who received customary nursing care. In addition, the performance of hand massage did not affect the flow or timing of procedures. Hand massage is an easy procedure for nurses to learn and administer, and it is within the scope of perioperative nursing practice. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.
Engstrand, Christina; Krevers, Barbro; Kvist, Joanna
Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Han...
Jafar Rafiei Kiasari
Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.
Moutet, F; Haloua, J P
Training of the hand surgeon HAND SURGEON A CONCEPT: The hand surgeon is supposed to be in charge of all the hand lesions regarding, skeleton, muscles, tendons, nerves and vessels. He has to be able to insure reparation and coverage of all of them. So he is involved in all the structures, which insure integrity and function of the hand. PURPOSE AND WAYS OF TRAINING: To obtain the asked ability, the hand surgeon training has to be global and sustained by two underlying surgical specialities: orthopedic surgery and plastic and reconstructive surgery. From 2000 after many years of dealings, a Right to the Title in Hand Surgery was born. This Right to the Title wants to be the formal recognition of the specific training of the hand surgeon. For the well-recognized ancient hand surgeons they need to be confirmed by one's peers. Now a day the hand surgeon has to satisfy to this specific training: Passed the complete training and exam of the Orthopedic or Plastic surgery board. Spent at least 6 months as resident in the other underlying specialty. Passed a microsurgery examination. Passed one of the four national Hand Surgery diplomas (DIU/Inter-Universitary Diploma). The examinations have been harmonized. A common formation is delivered regarding hand surgery, the way of examination is the same and the formation is 2 years long. The final exam is presented in front of board of examiners where a teacher of one of the other three national diplomas is present. Spent at least 2 years in a formative hand surgery unit, listed by the French College of Hand Surgeons, as senior surgeon. Those requirements are heavy to assume and need a heavy personal involvement. That seems to be necessary to have an ability level as high as possible. Emergency surgery practice is absolutely necessary in this training. All the 17 university formative hand surgery units listed by the French College of Hand Surgeons are members of the FESUM (European Federation of the Emergency Hand Units
Engstrand, Christina; Krevers, Barbro; Kvist, Joanna
Prospective cohort study. The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Safety and social issues of hand function and quality of life had an evident association with functional recovery. IV. Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Menendez, Mariano E; Mudgal, Chaitanya S; Jupiter, Jesse B; Ring, David
To determine the prevalence of and factors associated with limited health literacy among outpatients presenting to an urban academic hospital-based hand surgeon. A cohort of 200 English- and Spanish-speaking patients completed the Newest Vital Sign (NVS) health literacy assessment tool, a sociodemographic survey, and 2 Patient-Reported Outcomes Measurement Information System-based computerized adaptive testing questionnaires: Patient-Reported Outcomes Measurement Information System Pain Interference and Upper-Extremity Function. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy. Multivariable regression modeling was used to identify independent predictors of limited health literacy. A total of 86 patients (43%) had limited health literacy (English-speaking: 33%; Spanish-speaking: 100%). Factors associated with limited health literacy were advanced age, lower income, and being publicly insured or uninsured. Increasing years of education was a protective factor. Primary language was not included in the logistic regression model because all Spanish-speaking patients had limited health literacy. When evaluating health literacy on a continuum, primary language was the factor that most influenced the NVS scores, accounting for 14% of the variability. Limited health literacy was commonplace among patients seeing a hand surgeon, more so in elderly and disadvantaged individuals. We hope our study raises awareness of this issue among hand surgeons and encourages providers to simplify messages and improve communication strategies. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Kong, Sangwon; Lee, Kyung Soo; Kim, Junho; Jang, Seong Ho
Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength ...
... or asleep, depending on what you and the surgical team decide. You will not be able to see the surgery itself because a large sterile drape is placed between you and the surgeon. This is to protect the “sterile field,” the important area of your surgery, from any ...
Occupational therapists face a number of challenges in the after-treatment of rheumatoid hand surgery. They have to take into account the specialties of the surgery and the remaining deformities of the rheumatoid hand. Edema prophylaxis and scar treatment are similar for all patients, while splinting and functional training depend greatly on the different kinds of surgery. Both splinting and mobilization have to be adjusted to patient and process of the therapy. The protracted treatment requires a high compliance of the patient. Instruction and information about operation and postoperative therapy support comprehension and cooperation of the patient.
Gonnelli, D; Legré, R
In hand surgery, the patient often asks his surgeon if he is authorized to drive his car after the intervention. It is very difficult to answer making the distinction between medicolegal reality and misconceptions. Authors try to offer relevant answers. This paper is based on French laws governing the obtaining or the renewal of the driving license as published in traffic rules, penal code and official documents. The law defines the precise list of the "notifiable" medical conditions and disabilities incompatible with driving or requiring amendments. The patient must go through numerous stages to pass or renew a license (administrative procedures with the police, find a specialized driving school, medical examination, theoretical and practical examination). There are numerous developments adapted to vehicles. Possibilities of financing exist but are often difficult to obtain. The attitude towards insurance companies is not specified by the law but has to remain loyal and careful; the patient is nevertheless protected by the insurance code. The surgeon has to warn his patient of the new constraints imposed on him by his disability, whether temporary or definitive, but also to present him with the legal solutions. In conclusion, we propose an information sheet to assist the patients to regain their autonomy after surgery. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
The author summarizes the new therapeutic tendencies in hand surgery at the past one and a half decade. He discusses the development of hand surgery, as an independent field, in a form of a short historical summary, then he reviews in detail new therapeutic methods considered important such as rehabilitation procedures after tendon injuries, present position of complete hand transplantation, new operations of regeneration of the injured skin and repair of nerve damages, as well as the conservative therapeutic options of Dupuytren's disease. Finally he outlines the modified, new operative procedures in bone and joint injuries of the hand. He concludes that constant development of hand surgical knowledge will likely result in further novel therapeutic methods.
Kazuhiro P. Izawa
Full Text Available Background: The Disabilities of the Arm, Shoulder, and Hand (DASH questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m2; left ventricular ejection fraction: 53.5 ± 13.7%. Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = −0.38, p = 0.01 and with knee extensor muscle strength (r = −0.32, p = 0.04. Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.
K. A. Egiazaryan
Full Text Available Allen Bakner Kanavela's biography - the surgeon who has brought the invaluable contribution of a world scale in development of the general surgery and of hand surgery is presented.
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Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts. A consortium of 9 academic upper limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, scientific acceptability, usability, and feasibility of 44 candidate quality measures. These addressed hand problems the panelists felt were most appropriate for quality measure development. Panelists rated the measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 as equivocal or uncertain, and 7 to 9 as valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), the panelists were considered to be in agreement. If 3 or more of the panelists' ratings of a measure were within the 1 to 3 range and 3 or more ratings were in the 7 to 9 range, the panelists were considered to be in disagreement. There was agreement on 43% (19) of the measures as important, 27% (12) as scientifically sound, 48% (21) as usable, and 59% (26) as feasible to complete. Ten measures met all 4 of these criteria and were, therefore, considered valid measurements of quality. Quality measures that were developed address outcomes (patient-reported outcomes for assessment and improvement of function) and processes of care (utilization rates of imaging, antibiotics, occupational therapy, ultrasound, and operative treatment). The consortium developed 10
Kong, Sangwon; Lee, Kyung Soo; Kim, Junho; Jang, Seong Ho
To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.
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Liverneaux, P; Nectoux, E; Taleb, C
Robotics has spread over many surgical fields over the last decade: orthopaedic, cardiovascular, urologic, gynaecologic surgery and various other types of surgery. There are five different types of robots: passive, semiactive and active robots, telemanipulators and simulators. Hand surgery is at a crossroad between orthopaedic surgery, plastic surgery and microsurgery; it has to deal with fixing all sorts of tissues from bone to soft tissues. To our knowledge, there is not any paper focusing on potential clinical applications in this realm, even though robotics could be helpful for hand surgery. One must point out the numerous works on bone tissue with regard to passive robots (such as fluoroscopic navigation as an ancillary for percutaneous screwing in the scaphoid bone). Telemanipulators, especially in microsurgery, can improve surgical motion by suppressing physiological tremor thanks to movement demultiplication (experimental vascular and nervous sutures previously published). To date, the robotic technology has not yet become simple-to-use, cheap and flawless but in the future, it will probably be of great technical help, and even allow remote-controlled surgery overseas.
Full Text Available Laparoscopic surgery has been used extensively since it was first applied in the 1980s. The advantages are generally accepted and include less pain, smaller incisions, faster recovery, and shorter hospital stays. However, several limitations associated with standard laparoscopic surgery (SLS have become apparent and include the loss of tactile sensation, problems with the removal of bulky and intact specimens, and the restriction of visualization of the entire operating field. These problems with SLS helped to inspire the development of laparoscopically assisted surgery followed by hand-assisted laparoscopic surgery (HALS. In a hand-assisted laparoscopic procedure, an incision is made in the patient’s abdomen. Then, a uniquely designed appliance is introduced into the abdominal cavity through the incision to maintain pneumoperitoneum. With the inserting hand, surgeons can provide manual exposure, traction, palpation, and dissection because of the feedback of tactile sensation. HALS has gained acceptance for a wide range of abdominal procedures in general surgery and urology and is now feasible for complicated surgeries such as splenectomy, nephroureterectomy, and colectomy. It has been demonstrated in numerous specialties that HALS is a safe and efficacious technique that combines the benefits of laparoscopy with the advantages of a conventional laparotomy. Standard laparoscopic surgery also has limitations in gynecological surgery. A patient may have high risks with conventional laparoscopic surgery when she has deep invasive endometriosis, multiple or massive myoma, or dense pelvic adhesions from prior surgery. HALS overcomes many of the aforementioned limitations, has less conversion to open surgery, and broadens the indications for minimally invasive surgery, not only for benign tumors but also for pelvic malignancies.
Arifi, Hysni M; Duci, Shkelzen B; Zatriqi, Violeta K; Ahmeti, Hasan R; Haxhiu, Isa I; Mekaj, Agon Y; Gashi, Musli M; Buja, Zejn A; Derguti, Shkelqim H
Hands participate in everyday human activities and they are the most vulnerable parts of a human body. The objective of this study is to understand the common causes of hand burns, the methods of surgical interventions, duration of hospitalization and distribution of hand burns in 11 year period regarding the age. This is a retrospective study that included 572 patients with hand burns treated at the Department of Plastic Surgery Kosovo during the period 2000-2010. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package InStat 3. From statistical parameters were calculated structural index, arithmetic median and standard deviation. Data testing is done with X (2) test and the difference is significant if P<0.05. The Ministry of Health of our country should make efforts to organize training for health workers about treatment for minor burns in order to reduce the number of referral patients from other primary (Familiar Medicine) and secondary centers (regional Hospitals).
Alolabi, Noor; Chuback, Jennifer; Grad, Sharon; Thoma, Achilles
To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public. Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility. Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group. Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Albino, Frank P; Fleury, Christopher; Higgins, James P
Approaches to upper extremity anesthesia in hand surgery include regional blocks, wide-awake hand surgery with local anesthesia, and stellate ganglion blocks. Retrospective review of the literature from 2000 to 2014 published on the delivery of local and regional anesthesia during hand surgery. Included studies describe techniques of administration and treatment outcomes to identify common practices of pain management in hand surgery. Regional blocks provide sufficient anesthesia for hand surgery and have been found to improve postoperative pain and measured outcome scores. Wide-awake surgery offers many advantages including minimizing anesthetic risk and expense, permitting patient participation in operative evaluation, decreasing hospital time, and improving functional outcomes scores. Pain management in hand surgery can be achieved through regional blocks and wide-awake techniques that do not necessitate general anesthesia in an effort to improve safety, convenience, cost savings, and efficiency.
Mellema, Jos J; O'Connor, Casey M; Overbeek, Celeste L; Hageman, Michiel G; Ring, David
Patients and surgeons can feel uncomfortable discussing coping strategies, psychological distress, and stressful circumstances. It has been suggested that patient-reported outcome measures (PROMs) facilitate the discussion of factors associated with increased symptoms and disability. This study assessed the effect of providing feedback to patients regarding their coping strategy and illness behavior on patient satisfaction and patient-physician communication in orthopedic surgery. In a prospective study, 136 orthopedic patients were randomly assigned to either receive feedback about the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer-adaptive test (CAT) prior to the visit with the hand surgeon or not. The primary outcome was patient satisfaction with the consultation and secondary outcomes involved patient-physician communication. Bivariate and multivariable analyses were performed to determine the influence of the feedback on patient satisfaction and communication. There was no significant difference in patient satisfaction between patients who received feedback and patients who did not (P = 0.70). Feedback was associated with more frequent discussion of coping strategies (P = 0.045) in bivariate analysis but was not independently associated: in multivariable analysis, only PROMIS Pain Interference CAT and age were identified as independent predictors (odds ratio (OR) 1.1; 95 % confidence interval (CI) 1.0-1.1, P = 0.013, and OR 0.97, 95 % CI 0.94-0.99, P = 0.032, respectively). No factors were associated with discussion of stressors. Discussion of circumstances was independently associated with increased PROMIS Pain Interference CAT, marital status, and work status. We found that feedback regarding coping strategies and illness behavior using the PROMIS Pain Interference CAT did not affect patient satisfaction. Although feedback was associated with increased discussion of illness behavior in bivariate
Kamath, Jagannath; Shenoy, Trivikram; Jayasheelan, Nikil; Rizwan, Naufal; Sachan, Vartika; Danda, Rajashekar
Introduction: Wide awake surgery of the hand (WASH) is a well-accepted technique in hand surgery which allows the surgeon to identify and rectify on the table of some of the inadvertent shortcomings in the surgical procedures to optimise the final outcome. The advantage, however, precludes the use of tourniquet. We describe a modified method which preserves all the advantages of WASH and allows the surgeon to use tourniquet. Patients and Methods: Thirty-one cases of hand surgeries were carried out using the modified technique where a wrist block was supplemented with the ultra-short acting intravenous propofol which allowed the surgeon to use the upper arm tourniquet. The propofol infusion was stopped, and the tourniquet was released after the important surgical step. Within an average of 10 min of stoppage of the infusion, all the patients were awake for active intraoperative painless movements to aid the surgeon to identify, rectify and fine tune the procedure to optimise the results. Results: Five of the 31 patients needed correction based on the intraoperative movements. All the 31 patients were pain free at the surgical site during surgery. All the 31 patients were cooperative enough to perform full range of pain-free intraoperative movements. No patient experienced significant tourniquet pain during the procedure. Patient's and surgeon's satisfaction at the end of the procedure has been quite satisfactory. Conclusion: Timed wake-up anaesthesia, an improvement over the original WASH, has been suggested where the surgeon can add without subtracting the benefits of the procedure in the form of usage of the tourniquet providing the clear tissue plane and haemostasis during the surgery. However, an additional cost is incurred for the use of anaesthesia and equipment should be kept in mind. PMID:28216819
Noureldin, Mohamed; Habermann, Elizabeth B; Ubl, Daniel S; Kakar, Sanjeev
Unplanned readmission following surgery is a quality metric that helps surgeons assess initiatives targeted at improving patient care. We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to determine the rates, causes, and predictors of unplanned 30-day readmissions after outpatient elective hand and elbow surgery. The ACS-NSQIP database was queried using hand-and-elbow-specific Current Procedural Terminology (CPT) codes to retrospectively identify patients who had undergone outpatient hand or elbow surgery in 2012 and 2013. Patients who required an unplanned readmission to the hospital within 30 days were compared with those who were not readmitted. Preoperative patient characteristics, intraoperative variables, complications, and mortality were compared between the cohorts. Cox proportional hazard models were used to determine independent associations with 30-day unplanned readmission. A total of 14,106 outpatient hand or elbow surgery procedures were identified between 2012 and 2013, and 169 (1.2%) of them were followed by an unplanned readmission. The leading causes of readmission included postoperative infections (19.5%), pain (4.7%), thromboembolic events (4.1%), and pulmonary complications (3.0%). The causes of approximately 1/3 of the readmissions were missing from the database, and these readmissions were likely unrelated to the principal procedure. Independent predictors of readmission included an age of 70 to 84 years (hazard ratio [HR] = 2.83, 95% confidence interval [CI] = 1.67 to 4.78), smoking (HR = 2.23, 95% CI = 1.57 to 3.18), a lower hematocrit (HR = 2.19, 95% CI = 1.38 to 3.46), renal dialysis (HR = 3.32, 95% CI = 1.60 to 6.91), and an elbow procedure (with or without a hand procedure) (HR = 2.19, 95% CI = 1.57 to 3.04). The prevalence of unplanned readmission following outpatient hand and elbow surgery is low. Several modifiable factors, including preoperative smoking and anemia, are
Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki
MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264
Effectiveness of ondansetron as an adjunct to lidocaine intravenous regional anesthesia on tourniquet pain and postoperative pain in patients undergoing elective hand surgery: a systematic review protocol.
Badeaux, Jennifer; Bonanno, Laura; Au, Henry
The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists (ASA) class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. Both injury and deformity of the upper extremity can result in dysfunction to nerves, tendons and bones which can lead to disability and pain. Hand injuries and deformities encompass an area of upper extremity surgery, wherein isolation and accessibility to peripheral nerves allows for a wide range of anesthesia techniques. Common hand surgeries include carpal tunnel or trigger finger release, Dupuytren's contracture fasciectomy, tendon repair, and ganglion cyst removal. According to the extent of injury or deformity, a general anesthetic, regional anesthetic, monitored anesthetic care (MAC) or local anesthetic may be used for these hand surgeries. Depending on the injury or deformity, local anesthesia may not provide sufficient anesthesia, but a general anesthesia may not be completely warranted either. Typical elective hand surgeries performed under regional anesthesia and MAC may be the ideal anesthetic plan that balances adequate sedation and analgesia. Intravenous regional anesthesia (IVRA), commonly known as a bier block, is a safe and effective anesthetic and is typically utilized in uncomplicated hand or forearm surgeries lasting less than an hour. Intravenous regional anesthesia was first developed by August Bier in 1908 for anesthesia of the hand and forearm. It is a regional anesthetic technique that is easy to perform, with success rates up to 98%. Intravenous regional anesthesia is a simple, reliable and cost-effective anesthesia technique for short ambulatory hand surgery. The IVRA technique is ideal for American Society of Anesthesiologists (ASA) class 1 or 2 patients, which according to ASA classification, are individuals who are healthy
Agarwal, Jayant P; Mendenhall, Shaun D; Hopkins, Paul N
Plastic surgeons are often not perceived as hand surgery specialists. Better educating medical students about the plastic surgeon's role in hand surgery may improve the understanding of the field for future referring physicians. The purposes of this study were to assess medical students' understanding of hand surgery specialists and to analyze the impact of prior plastic, orthopedic, and general surgery clinical exposure on this understanding. An online survey including 8 hand-related clinical scenarios was administered to students at a large academic medical center. After indicating training level and prior clinical exposure to plastic surgery or other surgical subspecialties, students selected one or more appropriate surgical subspecialists for management of surgical hand conditions. A response rate of 56.4% was achieved. Prior clinical exposure to plastic, orthopedic, and general surgery was reported by 29%, 43%, and 90% of fourth year students, respectively. Students generally chose at least 1 acceptable specialty for management of hand conditions with improvement over the course of their training (P = 0.008). Overall, students perceived orthopedic surgeons as hand specialists more so than plastic and general surgeons. Clinical exposure to plastic surgery increased the selection of this specialty for nearly all scenarios (22%-46%, P = 0.025). Exposure to orthopedic and general surgery was associated with a decrease in selection of plastic surgery for treatment of carpal tunnel and hand burns, respectively. Medical students have a poor understanding of the plastic surgeon's role in hand surgery. If plastic surgeons want to continue to be recognized as hand surgeons, they should better educate medical students about their role in hand surgery. This can be achieved by providing a basic overview of plastic surgery to all medical students with emphasis placed on hand and peripheral nerve surgery.
Ferrari, Pier Francesco; Barbot, Anna; Bianchi, Bernardo; Ferri, Andrea; Garofalo, Gioacchino; Bruno, Nicola; Coudé, Gino; Bertolini, Chiara; Ardizzi, Martina; Nicolini, Ylenia; Belluardo, Mauro; Stefani, Elisa De
Studies of the last twenty years on the motor and premotor cortices of primates demonstrated that the motor system is involved in the control and initiation of movements, and in higher cognitive processes, such as action understanding, imitation, and empathy. Mirror neurons are only one example of such theoretical shift. Their properties demonstrate that motor and sensory processing are coupled in the brain. Such knowledge has been also central for designing new neurorehabilitative therapies for patients suffering from brain injuries and consequent motor deficits. Moebius Syndrome patients, for example, are incapable of moving their facial muscles, which are fundamental for affective communication. These patients face an important challenge after having undergone a corrective surgery: reanimating the transplanted muscles to achieve a voluntarily control of smiling. We propose two new complementary rehabilitative approaches on MBS patients based on observation/imitation therapy (Facial Imitation Therapy, FIT) and on hand-mouth motor synergies (Synergistic Activity Therapy, SAT). Preliminary results show that our intervention protocol is a promising approach for neurorehabilitation of patients with facial palsy. Copyright © 2017 Elsevier Ltd. All rights reserved.
Ronaldo Antonio de Freitas Novais Junior
Full Text Available Objective:Because of the received wisdom within our setting that claims that local anesthesia should not be used with adrenalin in hand surgery; we conducted a study using lidocaine with adrenalin, to demonstrate its safety, utility and efficacy.Methods:We conducted a prospective study in which, in wrist, hand and finger surgery performed from July 2012 onwards, we used local anesthesia comprising a 1% lidocaine solution with adrenalin at 1:100,000. We evaluated the quantity of bleeding, systemic alterations, signs of arterial deficit and complications, among other parameters. We described the infiltration techniques for specific procedures individually.Results:We operated on 41 patients and chose to describe separately the raising of a lateral microsurgical flap on the arm, which was done without excessive bleeding and within the usual length of time. In only three cases was there excessive bleeding or use of bipolar tweezers. No systemic alterations were observed by the anesthesiologists or any complications relating to ischemia and necrosis in the wounds or in the fingers, and use of tourniquets was not necessary in any case.Conclusions:Use of lidocaine with adrenalin in hand surgery was shown to be a safe local anesthetic technique, without complications relating to necrosis. It provided efficient exsanguination of the surgical field and made it possible to perform the surgical procedures without using a pneumatic tourniquet, thereby avoiding its risks and benefiting the patient through lower sedation.
Mueller, Melissa A; Zaydfudim, Victor; Sexton, Kevin W; Shack, R Bruce; Thayer, Wesley P
Wrist, hand, and finger trauma are the most common injuries presenting to emergency departments. Shortage of emergency hand care is an emerging problem, as on-call hand coverage declines. This study evaluates the availability of elective and emergency hand surgery services in Tennessee, with the use of telephone surveys administered to emergency department and operating facility management. One hundred eleven Tennessee hospitals completed the surveys (93% response rate). In all, 77% of hospitals offer elective hand surgery, 58% offer basic emergency hand services, 18% offer occasional hand specialist call coverage and only 7% of hospitals have 24/7 hand specialist call coverage. Hospitals with hand specialists have significantly more payer charges from commercial insurance than hospitals without hand specialists (26.1% vs. 16.1%, P call schedules, increasing incentives for call coverage, and training more hand specialists.
Rhee, Peter C; Fischer, Michelle M; Rhee, Laura S; McMillan, Ha; Johnson, Anthony E
Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. Economic/Decision Analysis IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Swiergosz, Andrew M; Kasdan, Morton L; Wilhelmi, Bradon J
Physicians should be aware of patients trying to obtain a diagnosis for secondary gain. Malingering is a diagnosis that should be suspected when objective findings do not support the subjective symptoms and there is secondary gain. A series of 21 cases are presented that support this position. The charts of 21 patients with a diagnosis of reflex sympathetic dystrophy (chronic regional pain syndrome) and nonanatomic findings were evaluated. The patients in this series were found to be malingering based on discrepancies between subjective symptoms and objective findings. The diagnosis of malingering should be based on thorough history, physical examination, electrodiagnostic studies, imaging studies, and evaluation of all medical records.
Albert, Mark G; Rothkopf, Douglas M
...; however, its importance in the OR has not been demonstrated. Objective To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery...
Albert, Mark G; Rothkopf, Douglas M
...; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery...
Nies, Matthew S; Bollinger, Alexander J; Cassidy, Charles; Jebson, Peter J L
To identify factors and attributes hand surgery fellowship program directors consider important in selecting applicants for interview and ranking. A web-based questionnaire was sent to all hand fellowship program directors in the United States. The questionnaire was designed to identify the most important criteria in granting an interview, sources of letters of recommendation, the interview process, and factors used to rank a candidate. Each criterion was ranked in importance on a 1 to 5 Likert scale, with 1 being not important and 5 being critical. All responses were anonymous. The most important criterion for each section of the survey was determined by comparing the average Likert scores. Fifty-two of 76 program directors responded (68%). The criteria with the highest mean Likert scores for offering an applicant an interview were, in order, quality letters of recommendation from hand surgeons, completion of an orthopedic surgery residency, comments regarding the applicant's technical competence, applicant having an MD degree (as opposed to a DO degree), and residency program reputation. The letters of recommendation with the highest value were from the division chief of hand surgery and another hand surgeon in the division/department. The most important features of the interview were maturity of applicant, ability of applicant to articulate thoughts, ability to listen well, self-confidence, and relevant questions asked. The most important factors in ranking a candidate were applicant integrity, commitment to hard work, quality of letters of recommendation, quality of the interview, and ability to work well with other members of the hand surgery team. There are identifiable factors considered important by hand surgery fellowship directors when selecting and ranking an applicant. This information may be valuable to medical students and residents contemplating careers in hand surgery. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier
Gordon, Chad R; Pryor, Landon; Afifi, Ahmed M; Gatherwright, James R; Evans, Peter J; Hendrickson, Mark; Bernard, Steven; Zins, James E
To the best of our knowledge, there have been no previous studies evaluating the correlation of the US economy and hand surgery volume. Therefore, in light of the current recession, our objective was to study our institution's hand surgery volume over the last 17 years in relation to the nation's economy. A retrospective analysis of our institution's hand surgery volume, as represented by our most common procedure (ie, carpal tunnel release), was performed between January 1992 and October 2008. Liposuction and breast augmentation volumes were chosen to serve as cosmetic plastic surgery comparison groups. Pearson correlation statistics were used to estimate the relationship between the surgical volume and the US economy, as represented by the 3 market indices (Dow Jones, NASDAQ, and S&P500). A combined total of 7884 hand surgery carpal tunnel release (open or endoscopic) patients were identified. There were 1927 (24%) and 5957 (76%) patients within the departments of plastic and orthopedic surgery, respectively. In the plastic surgery department, there was a strong negative (ie, inverse relationship) correlation between hand surgery volume and the economy (P economic times and vice versa during times of economic slowdown.
Ardizzone, Laura L; Smolowitz, Janice; Kline, Nancy; Thom, Bridgette; Larson, Elaine L
Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections. A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention. Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ(2)1 = 13.008, P = .0003]). This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Theddeus O. H. Prasetyono
Full Text Available BackgroundA pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent technique in hand surgery without a tourniquet.MethodsSeven patients (age range, 4 months to 37 years underwent hand or upper extremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury, contracture, constriction ring syndrome, or acrosyndactyly. A "one-per-mil" tumescent solution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline was used to create a bloodless operating field without a tourniquet. Observation was performed to document the amount of solution injected, the operation field clarity, and the postoperative pain.ResultsThe "one per mil" epinephrine solution showed an effective hemostatic effect. The tumescent technique resulted in an almost bloodless operation field in the tendon and in the constriction ring syndrome surgeries, minimal bleeding in the flap and contracture release surgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injected ranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeries showed mixed results. One flap was lost, while the others survived.ConclusionsEpinephrine 1:1,000,000 in saline solution is a potential replacement for a tourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival.
Trehan, Samir K; DeFrancesco, Christopher J; Nguyen, Joseph T; Charalel, Resmi A; Daluiski, Aaron
To evaluate factors associated with positive online patient ratings and written comments regarding hand surgeons. We randomly selected 250 hand surgeons from the American Society for Surgery of the Hand member directory. Surgeon demographic and rating data were collected from 3 physician review Web sites (www.HealthGrades.com, www.Vitals.com, and www.RateMDs.com). Written comments were categorized as being related to professional competence, communication, cost, overall recommendation, staff, and office practice. Online presence was defined by 5 criteria: professional Web site, Facebook page, Twitter page, and personal profiles on www.Healthgrades.com and/or www.Vitals.com. A total of 245 hand surgeons (98%) had at least one rating among the 3 Web sites. Mean number of ratings for each surgeon was 13.4, 8.3, and 1.9, respectively, and mean overall ratings were 4.0 out of 5, 3.3 out of 4, and 3.8 out of 5 stars on www.HealthGrades.com, www.Vitals.com, and www.RateMDs.com, respectively. Positive overall ratings were associated with a higher number of ratings, Castle Connolly status, and increased online presence. No consistent correlations were observed among online ratings and surgeon age, sex, years in practice, practice type (ie, private practice vs academics), and/or geographic region. Finally, positive written comments were more often related to factors dependent on perceived surgeon competence, whereas negative comments were related to factors independent of perceived competence. Physician review Web sites featured prominently on Google, and 98% of hand surgeons were rated online. This study characterized hand surgeon online patient ratings as well as identified factors associated with positive ratings and comments. In addition, these findings highlight how patients assess care quality. Understanding hand surgeon online ratings and identifying factors associated with positive ratings are important for both patients and surgeons because of the recent growth in
Nikac, Violeta; Weissman, Barbara N. [Harvard Medical School, Brigham and Women' s Hospital, Department of Radiology, Boston, MA (United States); Blazar, Philip; Earp, Brandon [Harvard Medical School, Brigham and Women' s Hospital, Department of Orthopedics, Boston, MA (United States)
Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable. (orig.)
Wang, Keming; Kowalski, Evan J; Chung, Kevin C
High-quality medical photography plays an important role in teaching and demonstrating the functional capacity of the hands as well as in medicolegal documentation. Obtaining standardized, high-quality photographs is now an essential component of many surgery practices. The importance of standardized photography in facial and cosmetic surgery has been well documented in previous studies, but no studies have thoroughly addressed the details of photography for hand surgery. In this paper, we provide a set of guidelines and basic camera concepts for different scenarios to help hand surgeons obtain appropriate and informative high-quality photographs. A camera used for medical photography should come equipped with a large sensor size and an optical zoom lens with a focal length ranging anywhere from 14 to 75 mm. In a clinic or office setting, we recommend 6 standardized views of the hand and 4 views for the wrist; additional views should be taken for tendon ruptures, nerve injuries, or other deformities of the hand. For intraoperative pictures, the camera operator should understand the procedure and pertinent anatomy in order to properly obtain high-quality photographs. When digital radiographs are not available and radiographic film must be photographed, it is recommended to reduce the exposure and change the color mode to black and white to obtain the best possible pictures. The goal of medical photography is to present the subject in an accurate and precise fashion. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Francesco M. Egro
Full Text Available Background Candidate characteristics for hand surgery fellowship training remains unknown, as very little data is available in the literature. This study aims to provide information on the criteria that are employed to select candidates for the hand surgery fellowship match. Methods A 38-question survey was sent in April 2015 to all Accreditation Council for Graduate Medical Education recognized hand surgery fellowship program directors (n=81 involved in the U.S. match. The survey investigated factors used for the selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from “not at all important” (1 to “essential in making my decision” (5; or for five controversial factors from “very negative impact” (1 to “very positive impact in making my decision” (5. Results A total of 52% (42 out of 81 of responses were received from hand surgery fellowship program directors. The most important influential factors were interactions with faculty during interview and visit (4.6±0.6, interpersonal skills (4.6±0.5, overall interview performance in the selection process (4.6±0.6, professionalism and ethics (4.6±0.7, and letters of recommendation from hand surgeons (4.5±0.7. Factors that have a negative impact on the selection process include visa requirement (2.1±1.2, graduate of non-plastic surgery residency program (2.4±1.3, and graduate of a foreign medical school (2.4±1.1. Conclusions This study provides data on hand surgery fellowship directors’ perception on the criteria important for fellowship applicant selection, and showed that interview-related criteria and letters of recommendation are the important factors.
Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T
The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.
Bersch, Ines; Fridén, Jan
The use of functional electrical stimulation (FES) to improve upper limb function is an established method in the rehabilitation of persons with tetraplegia after spinal cord injury. Surgical reconstruction is another well-established yet underused technique to improve the performance of the upper extremities. Hand surgery plays an essential role in restoring hand function, mobility, and quality of life in the tetraplegic population. The knowledge about the effects of FES on a structural and functional level is fundamental for understanding how and when FES can be used best to support the effect of hand surgery, both pre- and postoperatively. In this article we discuss principles of FES and how FES improves functional outcome after surgical reconstruction. The reported results are based on preliminary clinical observations. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Meals, Clifton; Osterman, Meredith
To investigate expectations, logistics, and costs relevant to the hand surgery fellowship application process. We sought to discover (1) what both applicants and program directors are seeking, (2) what both parties have to offer, (3) how both parties collect information about each other, and (4) the costs incurred in arranging each match. We conducted on-line surveys of hand surgery fellowship applicants for appointment in 2015 and of current fellowship program directors. Sixty-two applicants and 41 program directors completed the survey. Results revealed applicants' demographic characteristics, qualifications, method of ranking hand fellowship programs, costs incurred (both monetary and opportunity) during the application process, ultimate match status, and suggestions for change. Results also revealed program directors' program demographics, rationale for offering interviews and favorably ranking applicants, application-related logistical details, costs incurred (both monetary and opportunity) during the application process, and suggestions for change. Applicants for hand surgery fellowship training are primarily interested in a potential program's academic reputation, emphasis on orthopedic surgery, and location. The typical, successfully matched applicant was a 30-year-old male orthopedic resident with 3 publications to his credit. Applicants rely on peers and Web sites for information about fellowships. Fellowship directors are primarily seeking applicants recommended by other experienced surgeons and with positive personality traits. The typical fellowship director offers a single year of orthopedic-based fellowship training to 2 fellows per year and relies on a common application and in-person interviews to collect information about applicants. Applicants appear to be more concerned than directors about the current state of the match process. Applicants and directors alike incur heavy costs, in both dollars and opportunity, to arrange each match. A nuanced
This book remained almost the only standard text on hand care until the outbreak of World War II. During the intervening 25 years significant work in...such hand surgery was being done at the outbreak of World War II. Kanavel’s prin- ciples concerning the management of infections were accepted and...179, Anxiety states. See Psychotic patients, 208, 238, 263, 282, 283 (illus.), 296, categories of. 302, 303, 332, 352, 393, 394 (illus.), Arm boards
Adjoussou, S; Konan Blé, R; Séni, K; Fanny, M; Toure-Ecra, A; Koffi, A; Koné, M
The purpose of this study was to assess the value of hand disinfection by rubbing with alcohol in terms of prevention of surgical site infection (SSI) and cost in a tropical setting. This prospective cohort study carried out in the Gynecology Obstetrics Department of the Yopougon University Teaching Hospital from May to September 2005 was designed to compare two different methods of hand disinfection, i.e., traditional 3-step hand scrubbing using an antiseptic preparation versus handwashing without an antiseptic preparation followed by two applications of an aqueous alcohol solution. The study population included 318 patients who underwent surgery during the study period. The SSI rate was 13.2% in patients operated on after traditional hand scrubbing and 11.5% after handwashing followed by rubbing with alcohol (not significantly different). Hand disinfection by rubbing with alcohol did not increase the risk of SSI and was considered as easier than traditional hand scrubbing by 90% of users. Skin tolerance was deemed good by 52% of users. Most users (69%) wished both hand disinfection methods to be available. Hand disinfection by rubbing with alcohol was much more cost-effective than traditional hand scrubbing both with regard to initial investment and to consumable costs (50% lower). This study shows that hand disinfection by rubbing with an alcoholic solution is not only as effective as traditional hand scrubbing for prevention of SSI but also more cost-effective. These findings indicate that rubbing with alcohol is a suitable alternative to traditional scrubbing for hand disinfection prior to surgery in our tropical setting.
Wong, Jkf; Lin, C H; Chang, N J; Chen, H C; Lin, Y T; Hsu, C C
The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the 'wide-awake' anaesthetic technique. A temporary digital tourniquet (crisis. Four cases had minor superficial soft tissue necrosis that healed secondarily. We conclude that digital revascularization and replantation can be performed under local anaesthesia with use of adrenaline and without detriment to the traumatized digit provided careful patient selection and adequate operator experience are available. IV.
Busby, Sunni R; Kennedy, Bryan; Davis, Stephanie C; Thompson, Heather A; Jones, Jan W
The authors hypothesized that patients may not understand the forms of effective hand hygiene employed in the hospital environment. Multiple studies demonstrate the importance of hand hygiene in reducing healthcare-associated infections (HAIs). Extensive research about how to improve compliance has been conducted. Patients' perceptions of proper hand hygiene were evaluated when caregivers used soap and water, waterless hand cleaner, or a combination of these. No significant differences were observed, but many patients reported they did not notice whether their providers cleaned their hands. Educating patients and their caregivers about the protection afforded by proper, consistent hand hygiene practices is important. Engaging patients to monitor healthcare workers may increase compliance, reduce the spread of infection, and lead to better overall patient outcomes. This study revealed a need to investigate the effects of patient education on patient perceptions of hand hygiene. Results of this study appear to indicate a need to focus on patient education and the differences between soap and water versus alcohol-based hand sanitizers as part of proper hand hygiene. Researchers could be asking: "Why have patients not been engaged as members of the healthcare team who have the most to lose?"
Tander, Berna; Akpolat, Tekin; Durmus, Dilek; Canturk, Ferhan
Patients with end stage renal disease (ESRD) have many musculoskeletal abnormalities, including hand dysfunction. The Sollerman test evaluates hand grip function in daily activities. The relationships between Sollerman test (dominant hand) with Duruoz's Hand Index (DHI), Health Assessment Questionnaire (HAQ), and Beck Depression Inventory (BDI) tests have not been investigated previously. The aims of this study are to evaluate hand grip function using the Sollerman test in hemodialysis (HD) patients, correlate this test with other measures evaluating hand function or psychosocial status, and investigate factors that can affect Sollerman test. One-hundred twenty HD patients (64 male, 56 female, mean age 51 +/- 1.4 years, mean duration of HD therapy 5.3 +/- 3.7 years) were included in this study. The HAQ, DHI, and BDI scores were determined by standard techniques. All patients underwent the Jamar grip test and Sollerman test for the dominant (D) and non-dominant hand (ND). We found a positive correlation between Sollerman test (dominant hand) with Sollerman test-ND, Jamar-D, and Jamar-ND tests. There were negative correlations between Sollerman test with age, HAQ, BDI, and DHI tests. The relationships between Sollerman test (dominant hand) with DHI, HAQ, and BDI tests have not been investigated previously. This study showed the correlations between the Sollerman test (dominant hand) and other tests (either positive or negative). Psychosocial problems can affect hand functions.
Tulipan, Jacob; Miller, Andrew; Park, Andrew G; Labrum, Joseph T; Ilyas, Asif M
Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants' score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. The study confirms app validity and usefulness by demonstrating that every cohort's simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app's veracity and utility increased with lower levels of training experience.
Sproedt, J; von Campe, A; Bonaccio, M; Grünert, J G
Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented. Georg Thieme Verlag KG Stuttgart, New York.
Chan, Jeffrey C Y
Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting.
Long, Hao; Zheng, Yan; Situ, Dongrong; Ma, Guowei; Lin, Zhichao; Wang, Jinfeng
Complete resection of pulmonary metastases remains the standard of care for selected patients. An open approach causes criticism because of aggressiveness. Without manual palpation the video-assisted thoracic surgery procedure has the high probability of missing occult metastases. Transxiphoid bilateral lung metastasectomy surgery has not been widely adopted. We developed a hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through natural sternocostal triangle access in 2001 to solve the problems mentioned previously. We retrospectively evaluated 55 consecutive patients between 2001 and 2009 who underwent hand-assisted thoracoscopic surgery through sternocostal triangle access for pulmonary metastasis. Complications after operation, operative time, operative bleeding, air leak days, length of stay, preoperation imaging examination, and survival rate were evaluated. Fifty-five patients had lung metastases. Bilateral explorations were performed in a total of 51 patients, with a total of 201 minimal resections and one lobectomy. Nearly half of the patients with bilateral metastases were misdiagnosed as unilateral metastases by imaging examination. Intraoperative cardiac arrhythmia was experienced in 5.2% of the right and 10.5% of the left approaches. Postoperative complication rate was 3.6%. Three-year and five-year overall survival rates for metastatic disease were 59.8% and 47.2%, respectively. This new surgical procedure, with an assisted hand, could complete bilateral pleural exploration in a single operation through the natural sternocostal triangle. It is easy to perform and may help the patients gain a faster rehabilitation. Furthermore, it may lead to a better survival. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Bureck, W; Illgner, U
Human hands play an important role in overcoming routine daily life. As a consequence of limitations in the function of the hand due to rheumatic diseases, various manual activities can become an enormous challenge or even become absolutely impossible. This review article discusses the possibilities of hand ergotherapy and explains the most important assist devices. The main area of occupational and hand therapy interventions in patients with rheumatoid arthritis is the postoperative or conservative treatment of wrist and finger joints. The main areas of concern are to maintain the mobility of the joints, when necessary and possible mobilization of the joints, strengthen the muscles, the prophylaxis or correction of deformities with thermoplastic splints, conservative pain relief and anti-inflammatory treatment, joint protection precautions and teaching of home exercises for prophylaxis of contracture. Further areas of therapy are instruction and provision of adaptive devices for limitations of the upper and/or lower extremities, especially training of activities of daily living (ADL) and patient education.
Kii, Natsumi; Yamauchi, Masanori; Takahashi, Kazunobu; Yamakage, Michiaki; Wada, Takuro
This study determined the effective concentration of ropivacaine required to produce the type of differential block known as sensory block with mobilization, for adequate analgesia after forearm or hand soft tissue surgery by axillary brachial plexus block. Forty-four patients were enrolled, and ultrasound-guided axillary nerve block with nerve stimulation was achieved using 16 mL of ropivacaine in total. Postoperative analgesia and sensory/motor function, side effects, the use of rescue analgesics, and the patient satisfaction score were evaluated 24 h after surgery. The effective concentration of nerve block was calculated by probit analysis. Eighteen patients achieved differential block and were sufficiently satisfied with the block, which was significantly better than the patient satisfaction obtained with incomplete differential block. The maximum effective concentration of 6 mL of ropivacaine needed for differential block was calculated as 0.1285 %, which meant that 71 % of the patients experienced both sensory block and maintenance of motor function. This analysis showed that 16 ml of 0.1285 % ropivacaine is suitable for achieving differential block in ultrasound-guided axillary nerve block for hand and forearm surgery.
Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Ito, Kiyoshi; Hongo, Kazuhiro
In bypass surgery, a single-handed needle holder is usually used with other handed fine forceps. Recently, a needle holder with the function of fine forceps has been developed. In this technical note, usefulness of newly developed needle holders in both hands is presented in bypass surgery. With this method, surgeons can make stitches and ties by both hands without exchanging instruments. This method is effective and may result in faster anastomotic procedure comparing with the traditional one.
This podcast is for hospital patients and visitors. It emphasizes two key points to help prevent infections: the importance of practicing hand hygiene while in the hospital, and that it's appropriate to ask or remind healthcare providers to practice hand hygiene. Created: 5/1/2008 by National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID). Date Released: 6/19/2008.
Hagert, Elisabet; Lalonde, Donald
The epinephrine myth originated in the 1940s, when acidic (pH 1) procaine-epinephrine was injected into fingers, causing finger necrosis. Today, level 1 evidence exists for the safe use of epinephrine in fingers. The ability to use lidocaine-epinephrine in hand surgery and orthopedics eliminates the need for a tourniquet, or "bloodless field". Surgery using Wide Awake, Lidocaine-epinephrine Anesthesia, No Tourniquet (WALANT) reduces patient discomfort, facilitates patient participation in surgery, improves safe outcomes following reconstructions and greatly reduces the cost of medical care. Furthermore, patients regarded as high-risk can be safely treated without risk of cardiac or pulmonary side effects. In this manuscript, the background of the epinephrine myth is described, as well as recommended use of WALANT in hand surgery and orthopedics.
Wasfi Ehab I
Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.
Szczechowicz, Jakub; Pieniazek, Marek; Pelczar-Pieniazek, Maria
The aim of the study was to assess treatment efficacy in patients following surgery for carpal tunnel syndrome and compare hand function with patients' subjective evaluation and their ability to carry out activities of daily living. The study involved patients undergoing rehabilitation at the Małopolska Region Hand Rehabilitation Centre at L. Rydygier Specialized Hospital in Cracow and at the Hand Rehabilitation Unit at the Scanmed Medical Centre in Cracow. The patients were admitted to the Centre after surgical release of the transverse ligament of the wrist. Fifty hands (40 patients) were evaluated and treated. The rehabilitation programme was customised for each patient, and included patient education, a programme of home-based exercises and physiotherapeutic treatment in our centres. The patients were evaluated twice: before starting rehabilitation and at the end of the treatment. Hand function was evaluated using Swanson's method, the Alderson-McGall Hand Function Questionnaire and the Nine Hole Peg Test. Patients were also asked to provide a subjective evaluation of the typical signs and symptoms of CTS. The study showed improvement in all tests and a high level of correlation between various evaluations of hand function and patients' subjective feelings. The time at which post-operative rehabilitation was started significantly affected the outcomes of rehabilitation in the study group. There was a significant correlation between hand function impairment and subjective feelings of the patients vs. their quality of daily living.
Sears, Erika Davis; Larson, Bradley P.; Chung, Kevin C.
Background The aim of this study was to conduct a national survey of hand surgery fellowship program directors to determine differences of opinions of essential components of hand surgery training among program directors from plastic and orthopedic surgery programs. Methods We performed a web-based survey of 74 program directors from all ACGME accredited hand surgery fellowship programs to determine components that are essential for hand surgery training. The survey included assessment of 9 general areas of practice, 97 knowledge topics, and 172 procedures. 27 scales of related survey items were created to determine differences between specialty groups based on clinical themes. Results We had an 84% response rate, including 49 orthopedic and 12 plastic surgery program directors. There were significant differences in mean responses between the specialty groups in 11 of 27 scales. Only one scale, forearm fractures, contained items with a significantly stronger preference for essential rating among orthopedic surgeons. The other 10 scales contained items with a significantly higher preference for essential rating among plastic surgeons, most of which related to soft tissue injury and reconstruction. The burn scale had the greatest discrepancy in opinion of essential ratings between the groups, followed by pedicled and free tissue transfer, and amputation and fingertip injuries. Conclusions Despite being united under the subspecialty of hand surgery, program directors tend to emphasize clinical areas that are stressed in their respective primary disciplines. These differences promote the advantage of programs providing exposure to both plastic and orthopedic surgery trained hand surgeons. PMID:23446569
Fuller, Corey B; Wongworawat, Montri D; Riedel, Barth B
.... This study seeks to determine whether a hand surgeon receives a different amount of radiation exposure to their hands based on hand dominance and then accounting for this, provide a more accurate...
Владимир Иванович Заварухин
Full Text Available This article is a brief historical review of distraction osteogenesis development in hand surgery. It describes the key steps in the evolution of methods beginning with immobilization and external fixation up to the distraction method in orthopaedics and its introduction in hand surgery.
Hallock, Jennifer L; Handa, Victoria L; Rios, Rebeca
.... Underlying this investment is the belief that informing patients about the surgery promotes patient satisfaction with the decision for surgery and potentially satisfaction more broadly. Author Affiliation...
Full Text Available Polyurethane foam is generally used in negative pressure-assisted wound closure therapy. It provides an antimicrobial environment around the wound, while reducing the rate of skin maceration. The authors used polyurethane foam in routine hand dressings after hand surgery operations that were performed for both congenital and acquired purposes. [Hand Microsurg 2015; 4(3.000: 91-92
Lifchez, Scott D; Friedrich, Jeffrey B; Hultman, C Scott
There is no consensus among plastic surgeons regarding what constitutes the scope of hand surgery practice. Due to this lack, there is a wide variability in what hand surgery procedures plastic surgery resident will see and participate in during the course of training. We assessed what faculty members of plastic surgery training programs felt were contained within the scope of practice of hand surgery. A survey was sent to all members of the American Council of Academic Plastic Surgeons. Respondents reported size of department, faculty fellowship training, hand surgery call coverage, and amount of elective hand surgery within their training program. They also identified what procedures were within the scope of hand surgery. Ninety-three responses were received. Thirty-five respondents were certified or eligible for the surgery of the hand examination. Twenty-five respondents had 0 or 1 surgery-of-the-hand surgeon among their faculty. Thirty-nine departments/divisions performed 10 or fewer elective hand surgeries per week. Seventy-eight percent of groups taking hand call reported that all faculty members took hand call regardless of whether they had hand fellowship training. Although nearly all cover hand and wrist infections, only 49% provide care for distal radius fractures. In many residency programs, hand surgery exposure is in the setting of trauma and emergencies. The inclusion of complex elective hand surgeries within a plastic surgery practice and residency program allows residents to see the full spectrum of hand surgery. This allows them to make an informed decision regarding whether to seek subspecialty training and continue the participation of plastic surgeons in the full spectrum of hand surgery.
Full Text Available Purposes To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND that was performed in five pigs. Surgical Technique A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments. Comments The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required.
Riah, Y; Balaguer, T; Médard de Chardon, V; Chignon-Sicard, B; Dannan, E; Lebreton, E
In the case of multidigital hand trauma, the tissue of the amputated parts can be used for the reconstruction of the defected tissue localized on the other fingers. A series of seven patients has been reviewed in this paper; the authors illustrate the different possibilities of using the "spare-parts concept" in the emergency hand trauma surgery. The functional results are presented. The different techniques of reconstruction using the "spare-parts concept" are discussed. In the cases of multidigital lesions, the surgeon should choose the best opportunity to use the tissue of the amputated digits, or the non-conservable ones, to reconstruct the neighboring preserved segments. Copyright 2009 Elsevier Masson SAS. All rights reserved.
Wen, Rong; Tay, Wei-Liang; Nguyen, Binh P; Chng, Chin-Boon; Chui, Chee-Kong
Radiofrequency (RF) ablation is a good alternative to hepatic resection for treatment of liver tumors. However, accurate needle insertion requires precise hand-eye coordination and is also affected by the difficulty of RF needle navigation. This paper proposes a cooperative surgical robot system, guided by hand gestures and supported by an augmented reality (AR)-based surgical field, for robot-assisted percutaneous treatment. It establishes a robot-assisted natural AR guidance mechanism that incorporates the advantages of the following three aspects: AR visual guidance information, surgeon's experiences and accuracy of robotic surgery. A projector-based AR environment is directly overlaid on a patient to display preoperative and intraoperative information, while a mobile surgical robot system implements specified RF needle insertion plans. Natural hand gestures are used as an intuitive and robust method to interact with both the AR system and surgical robot. The proposed system was evaluated on a mannequin model. Experimental results demonstrated that hand gesture guidance was able to effectively guide the surgical robot, and the robot-assisted implementation was found to improve the accuracy of needle insertion. This human-robot cooperative mechanism is a promising approach for precise transcutaneous ablation therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Trehan, Samir K; Morrell, Nathan T; Akelman, Edward
To assess the accessibility and content of accredited hand surgery fellowship Web sites. A list of all accredited hand surgery fellowships was obtained from the online database of the American Society for Surgery of the Hand (ASSH). Fellowship program information on the ASSH Web site was recorded. All fellowship program Web sites were located via Google search. Fellowship program Web sites were analyzed for accessibility and content in 3 domains: program overview, application information/recruitment, and education. At the time of this study, there were 81 accredited hand surgery fellowships with 169 available positions. Thirty of 81 programs (37%) had a functional link on the ASSH online hand surgery fellowship directory; however, Google search identified 78 Web sites. Three programs did not have a Web site. Analysis of content revealed that most Web sites contained contact information, whereas information regarding the anticipated clinical, research, and educational experiences during fellowship was less often present. Furthermore, information regarding past and present fellows, salary, application process/requirements, call responsibilities, and case volume was frequently lacking. Overall, 52 of 81 programs (64%) had the minimal online information required for residents to independently complete the fellowship application process. Hand fellowship program Web sites could be accessed either via the ASSH online directory or Google search, except for 3 programs that did not have Web sites. Although most fellowship program Web sites contained contact information, other content such as application information/recruitment and education, was less frequently present. This study provides comparative data regarding the clinical and educational experiences outlined on hand fellowship program Web sites that are of relevance to residents, fellows, and academic hand surgeons. This study also draws attention to various ways in which the hand surgery fellowship application
Phillips, John H; Nish, Iain; Daskalogiannakis, John
After studying this article, the participant should be able to: 1. Identify the skeletal changes in the cleft patient that necessitate surgery. 2. Describe the orthodontic principles that precede surgical treatment. 3. Demonstrate the surgical principles involved in cleft orthognathic surgery and how to avoid common pitfalls particular to cleft orthognathic surgery. 4. Anticipate when dentoalveolar distraction can help in the treatment of problems not easily treated with conventional orthognathic techniques. This CME article covers the basic multidisciplinary approach to the treatment of patients requiring a combined orthodontic orthognathic approach to their skeletally based malocclusion. The dentoskeletal abnormalities are described for these patients, as are the fundamental orthodontic principles in the presurgical treatment of these patients. The basic surgical principles are discussed in general, and the reader is provided with advice on avoiding common pitfalls. Specific attention is given to the more recent advances in dentoalveolar distraction in cases of large defects that would have been difficult to treat using conventional orthognathic surgery. Videos are provided to illustrate the general principles in treating the cleft orthognathic patient and to illustrate the treatment of large defects using dentoalveolar distraction.
Chee, Kin Ghee; Puhaindran, Mark Edward; Chong, Alphonsus Khin Sze
Hand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments. This study aimed to determine the knowledge of hand surgery and hand surgical conditions among general practitioners. A questionnaire survey was conducted during a continuing medical education symposium on hand surgery in Singapore. Participants responded to 12 questions on hand trauma by keying the answers into a computer database system. The results were then analysed. A total of 35 general practitioners responded to our survey, and they were able to answer 53% of the questions correctly. We found knowledge gaps among the participants regarding hand surgical conditions, and identified areas where increased education during medical school, postgraduate training and continuing medical education may be beneficial. Areas that were found to be weak included recognising injuries that pose a high risk for developing wound infection, complications of topical steroid injection in trigger finger treatment and hand tumours. Improving hand surgery knowledge among general practitioners not only leads to improved primary care, but it can also facilitate prompt recognition of surgical problems and subsequent referral to appropriate hand surgeons for treatment. This may possibly reduce the load of tertiary institutions in treating non-urgent hand conditions.
Nica, Adriana Sarah; Brailescu, Consuela Monica; Scarlet, Rodica Gabriela
In the last decade, Virtual Reality has encountered a continuous development concerning medical purposes and there are a lot of devices based on the classic "cyberglove" concept that are used as new therapeutic method for upper limb pathology, especially neurologic problems [1;2;3]. One of the VR devices is Pablo (Tyromotion), with very sensitive sensors that can measure the hand grip strenght and the pinch force, also the ROM (range of motion) for all the joints of the upper limb (shoulder, elbow, wrist) and offering the possibility of interactive games based on Virtual Reality concept with application in occupational therapy programs. We used Pablo in our study on patients with hand surgery as an objective tool for assessment and as additional therapeutic method to the classic Rehabilitation program [4;5]. The results of the study proved that Pablo represents a modern option for evaluation of hand deficits and dysfunctions, with objective measurement replacement of classic goniometry and dynamometry, with computerized data base of patients with monitoring of parameters during the recovery program and with better muscular and neuro-cognitive feedback during the interactive therapeutic modules.
Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....
Coronel Brizio, P; Olivares Nowak, J; Palafox Sánchez, F
To establish a precise definition for the geriatric patient, results difficult, since the age limits change constantly and arbitrary way, but given that women are living longer, supposedly the rate of gynecologic surgery is increasing. To inform the experience obteined in our service, from geriatric patients, with surgical intervention, and compare the results with published articles from other national gynecology services. In the gynecology service of Specialties Hospital "Dr. Miguel Dorantes Mesa" from the S.S., in Xalapa Veracruz, México, a retrospective study was performed, from 76 cases of patients with gynecologic surgery. The research variables were: 60 years old or older, personal pathologic data, gynecologic and obstetrics, occupation, preoperative diagnosis, type of intervention, anatomopathologic diagnosis, anesthesia employed, complications during of after surgery, days in the hospital, hemoglobin and hematocrit. Most of the patients were 65 to 70 years old, 100% housewives, pelvic statics alterations were present in most cases (53.9%), followed by pre-malignant and malignant diseases of the cervix, the abdominal hysterectomy was indicated in 29 cases, 65.7% had personal pathologic data, the anatomopathologic study confirmed 85% of the cases, days-hospital average was 5.8. Survivorship does not depend by type of surgery or age, if not to concomitant illness.
van der Linde, H; Snoek, GJ; Knoop, HA; Mulder, T
To determine whether surgical key grip reinforcement actually leads to a better movement ability we developed a procedure for the kinematic analysis of manual skill following hand surgery in tetraplegia. The functional results of surgery in 5 cases were examined by the kinematic analysis of drawing
Silveira, Thalita Morgana Guimarães; Sousa, Juliana Barbosa de; Stringhini, Maria Luiza Ferreira; Freitas, Ana Tereza Vaz de Souza; Melo, Paulla Guimarães
The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values of the population by sex and age, for the classification of nutritional risk. The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (nutritional subjective assessment with anthropometric methods and strength of the handshake only at the non-dominant limb.
Haverstick, Stacy; Goodrich, Cara; Freeman, Regi; James, Shandra; Kullar, Rajkiran; Ahrens, Melissa
Hand hygiene is important to prevent hospital-acquired infections. Patients' hand hygiene is just as important as hospital workers' hand hygiene. Hospital-acquired infection rates remain a concern across health centers. To improve patients' hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients' education to reduce hospital-acquired infections. In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff. Significant correlations were found between hand hygiene and rates of infection with vancomycin-resistant enterococci (P = .003) and methicillin-resistant Staphylococcus aureus (P = .01) after the intervention. After the implementation of hand hygiene interventions, rates of both infections declined significantly and patients reported more staff offering opportunities for and encouraging hand hygiene. This quality improvement project demonstrates that increased hand hygiene compliance by patients can influence infection rates in an adult cardiothoracic step-down unit. The decreased infection rates and increased compliance with hand hygiene among the patients may be attributed to the implementation of patient education and the increased accessibility and use of hand sanitizer. ©2017 American Association of Critical-Care Nurses.
Long Hao; Jiang Long; Lin YongBin; Situ DongRong; Zheng Yan; Zhang YiGong; Ma GuoWei
Hand-Assisted Thoracoscopic Surgery for pulmonary metastasectomy through sternocostal triangle access allows manual palpation of both lungs, thus permitting effective treatment of lung metastases. In our research, 62 patients from November 2001 to January 2012 underwent our Hand-Assisted Thoracoscopic Surgery procedures for pulmonary metastasectomy. Clinical data, including the number of pulmonary metastases determined by Computed Tomography/Positron Emission Tomography-Computed Tomography, s...
Chung, Karen Y; Hanemaayer, Amanda; Poenaru, Dan
There is emerging interest in hand surgery and global health. This was emphasized at the 2015 presidential address at the American Society for Surgery of Hand. Children are prioritized because of their increased risk for trauma and higher potential for better outcomes. This study aims to identify how hand surgical volunteer programs can benefit the pediatric hand surgical landscape in global health. There has been no literature review to date. This institutional review board-approved review systematically searched PubMed, Embase, Medline, African Journal Online, and the Journal of Hand Surgery. A scoping review methodology was selected to allow mapping of a body of literature by topic, include a greater range of study designs, and provide a descriptive overview of the reviewed material. All studies published between 2000 to March 2016 relevant to pediatric hand surgery in global health were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to record the search results. Six hundred sixty-eight citations were reviewed, with 10 studies that satisfied the inclusion criteria. Hand trauma (70%), congenital anomalies (30%), tumors (20%), surgical technique (50%), and international outreach recommendation (30%) were common themes. Targeting prevention (50%), international outreach education (30%), and building on previous studies to validate findings study (10%) were identified as gaps.
http://creativecommons.org/licenses/by-nc-nd/4.0. The bariatric surgery patient for non-bariatric surgery. B Dayaa*. aSpecialist Anaesthesiologist, Inkosi Albert Luthuli Central Hospital, Durban. *Corresponding author: Bhavika Daya, e-mail: firstname.lastname@example.org. Table II: Co-morbidities frequently found in obese patients.
Full Text Available Background:Patient satisfaction with the cosmetic result of spinal fusion surgery was studied in 40 cases of adolescent idiopathic scoliosis.Neutral or dissatisfied patients were compared with satisfied patients in several physical and psychological characteristics. The aim of the study was to determine whether adolescents generally report satisfaction with the postoperative appearance of their back after the correction of severe curves and whether preoperative medical and/or psychological factors could distinguish between patients who report satisfaction with the cosmetic surgical result from those who report neutrality or dissatisfaction. Previous reports emphasize the need for medical outcome research that evaluates both patient satisfaction and technical success. Patient satisfaction with spinal surgery has largely been evaluated in retrospective studies and most consistently is related to postoperative cosmesis and degree of curve correction. Methods: 40 adolescents with idiopathic scoliosis without any comorbidity who were 10 years of age or older were studied preoperatively by physical and psychological measurements. Results: Of patients undergoing surgical correction of severe curves, 50% reported satisfaction with the cosmetic result. Neutral or dissatisfied patients were more likely to have a King II or King IV curve types and less correction than satisfied patients. Preoperative psychological difficulties (P< 0.05 and unmet expectations regarding postoperative cosmesis (P<0.05 were more common among neutral or dissatisfied patients. Conclusion: Most adolescents with idiopathic scoliosis expressed satisfaction with the cosmetic surgical result. Preoperative physical characteristics, psychological difficulties, and unrealistic expectations regarding postoperative cosmesis are associated with patient neutrality or dissatisfaction.
Nolte, Michael T; Shauver, Melissa J; Chung, Kevin C
The Michigan Hand Outcomes Questionnaire has been widely used for nearly 20 years to assess patients with a variety of hand and upper extremity conditions. However, normative data have not previously been collected, limiting interpretation. The Michigan Hand Outcomes Questionnaire was administered to 579 participants recruited from the general population. In addition, participants were asked to identify any problem affecting their hand(s), including trauma, hand disease/condition, systemic illness, or nonspecific symptoms. Comorbidities and demographic data were also collected. Total Michigan Hand Outcomes Questionnaire score for healthy individuals was indicative of generally good hand function (95.2; 95 percent CI, 94.3 to 96.1). Individuals with unilateral trauma scored for their affected hand (90.3; 95 percent CI, 87.9 to 92.6) lower than their healthy hand (mean difference, 5.7; 95 percent CI, 3.2 to 8.3). For individuals with and without hand trauma, total Michigan Hand Outcomes Questionnaire score decreased with increasing number of comorbidities. Many of the differences in Michigan Hand Outcomes Questionnaire score between the problem hand and unaffected hand were smaller than the minimal clinically important difference of 3.0 to 23.0 for known abnormalities of the hand and upper extremity. These normative data provide appropriate baseline information for individuals with and without underlying hand conditions. Most notably, these findings suggest that individuals with a unilateral problem establish new subnormative values for both their affected and unaffected hands. These data will encourage an appropriate understanding of the results of future studies using the Michigan Hand Outcomes Questionnaire.
Fansa, H; Haller, S
Aesthetic surgery is a service which entails a high degree of trust. Service evaluation prior to provision is difficult for the patient. This leads to the question of how to manage the service successfully while still focusing on the medical needs. The decision to undergo an operation is not influenced by the operation itself, but by preoperative events which induce the patient to have the operation done. According to "buying decisions" for products or in service management, the decision for an aesthetic operation is extensive; the patient is highly involved and actively searching for information using different directed sources of information. The real "buying decision" consists of 5 phases: problem recognition, gathering of information, alternative education, purchase decision, and post purchase behaviour. A retrospective survey of 40 female patients who have already undergone an aesthetic operation assessed for problem recognition, which types of information were collected prior to the appointment with the surgeon, and why the patients have had the operation at our hospital. They were also asked how many alternative surgeons they had been seen before. Most of the patients had been thinking about undergoing an operation for several years. They mainly used the web for their research and were informed by other (non-aesthetic) physicians/general practitioners. Requested information was about the aesthetic results and possible problems and complications. Patients came based on web information and because of recommendations from other physicians. 60% of all interviewees did not see another surgeon and decided to have the operation because of positive patient-doctor communication and the surgeon's good reputation. Competence was considered to be the most important quality of the surgeon. However, the attribute was judged on subjective parameters. Environment, office rooms and staff were assessed as important but not very important. Costs of surgery were ranked second
Gonzalez-Sánchez, Juan A; Corujo-Vázquez, Omar; Sahai-Hernández, Mrisa
Morbid obesity prevalence is reaching epidemic proportions in Western society. Long-term weight loss can be achieved by bariatric surgery. This surgery also has a positive impact in the reduction of obesity related co-morbid conditions. The purpose of this study is to determine the reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery. A retrospective chart review study was performed at the UPR Hospital in Carolina. Patients with the diagnosis of morbid obesity who had bariatric surgery were identified. Of the 283 patients who met the criteria, the following information was obtained: gender, age, height, weight, pre-operative BMI, obesity-related comorbid conditions, post operative length of stay (LOS), and reasons and length of stay of Emergency Department (ED) visits within a 3 month period after surgery. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) Program. The same profile of gender and BMI was obtained between the population that had the surgery and the sample that visited the ED, the group of patients between 20-29 years old was more likely to visit the ED. No correlation was found between a longer post operative length of stay and an increased probability of visiting the ED. Of the population, 5% had to visit ED within a three month period. The most common post operative complications were: Abdominal Pain (46.2%), Emesis (38.5%), and Dehydration (30.8%). Other less frequent complications were nausea, DVT, pneumonia, dizziness, gastritis, infected wound and upper GI bleeding. The most common reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery were: abdominal pain, emesis, dehydration and nausea. These complications could most likely be attributed to patient poor compliance with diet, resulting in the classical symptoms of the dumping syndrome which is common in patients that have undergone
Barker, Anna; Sethi, Ajay; Shulkin, Emily; Caniza, Rachell; Zerbel, Sara; Safdar, Nasia
We examine factors associated with hand hygiene practices of hospital patients. Hygiene decreased compared to at home, and home practices were strongly associated with hospital practices. Understanding and leveraging the intrinsic value some patients associate with hand hygiene may be important for improving overall hospital hygiene and decreasing healthcare-associated infections.
Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.
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
Avery, Daniel M; Matullo, Kristofer S
To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Cheng, Vincent C C; Tai, Josepha W M; Li, W S; Chau, P H; So, Simon Y C; Wong, Lisa M W; Ching, Radley H C; Ng, Modissa M L; Ho, Sara K Y; Lee, Doris W Y; Lee, W M; Wong, Sally C Y; Yuen, K Y
The importance of compliance with hand hygiene by patients is increasingly recognized to prevent health care-associated infections. This descriptive study observed the effects of an education campaign, targeted to increase patients' self-initiated hand hygiene, and a hand hygiene ambassador-initiated directly observed hand hygiene program on patients' hand hygiene compliance in a university-affiliated hospital. The overall audited compliance of patients' self-initiated hand hygiene was only 37.5%, with a rate of 26.9% (112/416 episodes) before meals and medications, 27.5% (19/69 episodes) after using a urinal or bedpan, and 89.7% (87/97 episodes) after attending toilet facilities. Patients referred from a residential care home for older adults had significantly lower hand hygiene compliance (P = .007). Comparatively, the overall audited compliance of ambassador-initiated directly observed hand hygiene was 97.3% (428/440 episodes), which was significantly higher than patients' self-initiated hand hygiene via a patient education program (37.5%, 218/582 episodes, P hand hygiene can play an important role in improving compliance with hand hygiene by hospitalized patients. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
da Silveira, Eduardo Almeida; Bubeck, Kirstin A; Batista, Edisleidy Rodriguez; Piat, Perrine; Laverty, Sheila; Beauchamp, Guy; Archambault, Marie; Elce, Yvonne
This prospective clinical study evaluates the effectiveness of an alcohol-based hand rub (Avagard™) for pre-surgical hand antisepsis in an equine hospital and compares it with traditional scrubbing technique using 4% chlorhexidine gluconate sponges and water. Prior to elective surgery, 3 board-certified surgeons were randomly assigned to hand antisepsis with either technique. Culture samples of each hand were taken at 4 times: before and after neutral soap hand wash, after scrub or rubbing technique, and after surgery. There was no significant difference in mean bacterial colony forming units between scrub and rub techniques over the 3 time periods (P = 0.6), controlling for initial counts. One horse from the scrub group had a skin incision infection following stifle arthroscopy; this was resolved with medical treatment. The alcohol-based hand rub is equivalent in efficacy for pre-surgical hand antisepsis to traditional water-based scrubs in an equine hospital setting.
Kung, Jennifer S.; Choi, Daniel Y.; Cheema, Anjum S.; Singh, Kuldev
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-establishing perimetric and optic nerve imaging baselines is recommended after cataract surgery. The sequence of cataract surgery relative to glaucoma surgery impacts the likelihood of complications and surgical success. There are multiple benefits to perform cataract surgery prior to glaucoma surgery while cataract surgery after trabeculectomy increases the risk of subsequent filtration failure. As “minimally invasive glaucoma surgeries” continue to improve in terms of efficacy, there is an evolving role for combined cataract and glaucoma surgery in patients with early to moderate stages of glaucoma. PMID:25624668
Shabanzadeh, Daniel M; Sørensen, Lars T
: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....
Siti Nur Baait Biniti Mohd Sokran
Full Text Available Background: Hand grip strength (HGS is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2 index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery. Methods: Twenty-seven patients with CAD had HGS were assessed using handheld dynamometer. HGS for each hand were documented. MVO2 index was assessed using rate pressure product (RPP, which is the product of the heart rate (HR and systolic blood pressure (SBP. Repeated measures MANOVA were carried out to estimate the interaction between both hands HGS and MVO2 index before and after surgery. Results: There was significant interactions (P<0.001 for both HGS dominant and non-dominant with large effect sizes (HGS dominant×MVO2 index: hp2=0.44; HGS dominant×RPP: hp2=0.49. This signifies that peripheral muscle strength of the upper limb (HGS dominant and non-dominant had different effects on MVO2 index before and after surgery. The interaction graph shows that the increase in MVO2 index after surgery was significantly greater for peripheral muscle strength of the dominant hand when compared to non-dominant. Conclusion: Patients with CAD had interactions between HGS and oxygen consumption before and after surgery. Hence, HGS might be used as a predictor to assess oxygen consumption among cardiac patients.
such as age, and gender, clinical findings, history of surgery, etc., extracted from archived files of the patients undergoing ... between gender and dacryocystitis rate, it was high among female (P = 0.02( Most of the patients complained of ... at 3 months after surgery and a healed patent neo-ostium with a free flow of tears from ...
Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas
nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...... with high perioperative rates of MACE and mortality, but perhaps prognosis is, in practice, not much worse for patients with AS than for matched controls. Symptomatic patients and patients undergoing emergency surgery are at considerable risks of a MACE and mortality....
Wongkietkachorn, Apinut; Boonyawong, Pangpoom; Rhunsiri, Peera; Tantiphlachiva, Kasaya
Most patient education involves passive learning. To improve patient education regarding surgery, an active learning workshop-based teaching method is proposed. The objective of this study was to assess level of patient surgical knowledge, achievement of workshop learning objectives, patient apprehension about future surgery, and participant workshop satisfaction after completing a surgical training workshop. A four-station workshop (surgical scrub, surgical suture, laparoscopic surgery, and robotic surgery) was developed to teach four important components of the surgical process. Healthy, surgery-naive adolescents were enrolled to attend this 1-h workshop-based training program. Training received by participants was technically and procedurally identical to training received by actual surgeons. Pre- and post-workshop questionnaires were used to assess learning outcomes. There were 1312 participants, with a mean age 15.9 ± 1.1 years and a gender breakdown of 303 males and 1009 females. For surgical knowledge, mean pre-workshop and post-workshop scores were 6.1 ± 1.5 and 7.5 ± 1.5 (out of 10 points), respectively (p workshop satisfaction scores were all higher than 4.5. Active, hands-on patient education is an effective way to improve understanding of surgery-related processes. This teaching method may also decrease apprehension that patients or potential patients harbor regarding a future surgical procedure.
Patients recovering from hand surgery frequently ask when it is safe to drive and it is unclear where the responsibility lies; the surgeon, the patient or the insurance company. An eight-question survey looking at various aspects of clinical practice was circulated to consultant and trainee plastic and orthopaedic surgeons in Ireland and the UK. Of the 89 surgeons who replied, (53%) felt the decision when to drive was the patient’s compared with the insurance company (40%) and the surgeon (7%). 80% advised patients to contact their insurance company. 87% were unaware of current regulations or guidelines. National guidelines were vague and left the decision with the treating doctor. Similarly, major insurers advise patients to contact their doctor for advice. From a legal standpoint, the patient has a duty of care to other road users to be in full control of his vehicle prior to driving, regardless of any advice received.
Full Text Available Le Fort I osteotomy is usually combined with mandibular ramus procedures (sagittal split in order to correct dentofacial deformities that cause malocclusion. Patients who have dentofacial anomalies involving the maxilla carry a higher risk of difficulty in breathing due to septal deviation and inferior turbinate hypertrophy. If these conditions are ignored preoperatively, severe airway problems may come up after orthognathic surgery. A detailed examination regarding nasal airway should be conducted in such patients, and they should be informed about their condition which may require an additional intervention during or after their main surgery.
L. A. Rodomanova
Full Text Available Objective - to determine the optimal implant for metacarpophalangeal joint arthroplasty in patients with rheumatoid hand. Materials and methods. 24 patients with rheumatoid hand were operated in Vreden Russian Research Institute of Traumatology and Orthopedics (St.-Petersburg, Russia. 37 MCPJ arthroplasties were performed with 129 implants of 3 types. First group consisted of 11 patients with 43 implanted NeuFlex “DePuy International Ltd.” silicone implants on 12 hands. Second group - 6 patients with 26 implants Daphne “TECRES S.p.A.” on 7 hands. Third group - 16 patients with 60 implants RM Finger “MATHYS AG Bettlach” on 17 hands. Criteria for treatment effectiveness were estimated taking into account hand function, complications and also relapse of deformation. We compared movement amplitude in MCP joins, angle of ulnar drift, strength of hand and also subjective assessment by patients with DASH. Results were fixed before surgery and 3, 6 and 12 months after. Results. Complications were recorded in I and II of patient groupsin 50% of cases:fracturesof components, dislocations of construction, relapse of ulnar drift. Complications in III group of patients were not detected. Range of motion and function improvement were increased in all groups (p>0,05, as well as strength of hand. But the most stable growth of hand strength was fixed only in III group (p<0,05. Relapse of ulnar drift occurred in I group of patients. Conclusion. RM Finger “MATHYS AG Bettlach” is more reliable for metacarpophalangeal joint arthroplasty since it provides stable long-term results of treatment.
Therattil, Paul J; Yueh, Janet H; Kordahi, Anthony M; Cherla, Deepa V; Lee, Edward S; Granick, Mark S
Outpatient wound care plays an integral part in any plastic surgery practice. However, compliance with hand hygiene measures has shown to be low, due to skin irritation and lack of time. The objective of this trial was to determine whether single-use, long-acting antiseptics can be as effective as standard multiple-use hand hygiene methods in an outpatient surgical setting. A prospective, randomized controlled trial was performed in the authors' outpatient plastic surgery clinic at Rutgers New Jersey Medical School, Newark, NJ to compare the efficacy of an ethyl alcohol-based sanitizer (Avagard D Instant Hand Aniseptic, 3M Health Care, St. Paul, MN), a benzalkonium chloride-based sanitizer (Soft & Shield, Bioderm Technologies, Inc, Trenton, NJ, distributed by NAPP Technologies, Hackensack, NJ ), and soap and- water handwashing. Subjects included clinic personnel, who were followed throughout the course of a 3-hour clinic session with hourly hand bacterial counts taken. During the course of the trial, 95 subjects completed the clinic session utilizing 1 of the hand hygiene methods (36 ethyl alcohol-based sanitizer, 38 benzalkonium chloride-based sanitizer, and 21 soap-and-water handwashing). There was no difference between hand bacterial counts using the different methods at 4 hourly time points (P greater than 0.05). Hand bacterial counts increased significantly over the 3-hour clinic session with the ethyl alcohol-based sanitizer (9.24 to 21.90 CFU, P less than 0.05), benzalkonium chloride-based sanitizer (6.69 to 21.59 CFU, P less than 0.05), and soap-and-water handwashing (8.43 to 22.75 CFU, P less than 0.05). There does not appear to be any difference in efficacy between single-use, long-acting sanitizer, and standard multiple-use hand hygiene methods. Hand bacterial counts increased significantly over the course of the 3-hour clinic session regardless of the hand hygiene measure used. Hand condition of subjects was improved with the ethyl alcohol
Thaís Silva Barroso
Full Text Available ABSTRACT BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP and the JBJS/AAOS levels of evidence and grades of recommendations (LOR. Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016. RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8% and private institutions (65%, with self-funding (91.8%. Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13. CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.
Furukawa, Kiyonori; Tajiri, Takashi; Suzuki, Hideyuki; Norose, Yoshihiro
To examine whether sterile water and brushes are necessary for hand washing before surgery. Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.
M. Sami Walid
Full Text Available Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis. Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test. Results: Of 4,958 spine surgery patients 364 (7.3% were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries. Among primary patients (N=327 the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364. This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same. The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients. Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.
McGuckin, M; Govednik, J
Multi-modal hand hygiene programmes that include patient empowerment are promoted as a necessary component of hand hygiene compliance. However, the question still remains, do we have enough information to determine if, and under what conditions, patients will be able to play an immediate role in healthcare workers' hand hygiene behaviour? To review the current literature on patient willingness to be empowered, barriers to empowerment, and hand hygiene programmes that include patient empowerment and hand hygiene improvement. A Medline (Ovid) search of all English-language papers for 1997-2007 and 2008-2012 was conducted using the following keywords alone and in various combinations: 'patient participation', 'involvement', 'empowerment', 'education', 'decision-making', 'professional-patient relations', 'behavioural change', 'culture of safety', 'social marketing', 'consumer awareness', 'leadership', 'institutional climate', 'hand hygiene' and 'patient reminders'. The 1997-2007 review was conducted as part of the World Health Organization's Guidelines on Hand Hygiene in Health Care, and updated with the 2008-2012 review. Several studies show that, in principle, patients are willing to be empowered. However, there is variation in the actual number of patients that practice empowerment for hand hygiene, ranging from 5% to 80%. The actual performance of patient empowerment can be increased when a patient is given explicit permission by a healthcare worker. There is ongoing support from patients that they are willing to be empowered. There is a need to develop programmes that empower both healthcare workers and patients so that they become more comfortable in their roles. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Dukatz, Thomas; Sarnthein, Johannes; Sitter, Helmut; Bozinov, Oliver; Benes, Ludwig; Sure, Ulrich; Bertalanffy, Helmut
Symptomatic patients with a brainstem cavernoma are treated surgically with increasing frequency. Generally, the patient's benefit from this difficult surgical intervention is quantified by the assessment of neurological symptoms. To document the beneficial effect of surgery in a larger patient population by assessing the postoperative quality of life (QoL). In a series of 71 surgically treated patients, a detailed neurological status was assessed by Patzold Rating and Karnofsky Performance Status Scale. Patients rated their QoL with the Short Form 36 Health Survey. To document the effect of surgery on QoL, we devised a supplementary questionnaire. The last 24 patients completed Short Form 36 Health Survey pre- and postoperatively. Karnofsky Performance Status Scale improved in 44 of 71 surgical patients (62%), remained unchanged in 19 (27%), and deteriorated in 8 (11%) individuals. Patzold Rating showed a more detailed picture of the neurological symptoms. It correlated significantly with Karnofsky Performance Status Scale, which underscores its usefulness for patients with brainstem lesions. In the Short Form 36 Health Survey score, the Mental Component Summary improved with surgery (paired test, P = .015). In addition, 58 individuals (82%) declared a clear subjective benefit of surgery. The results of this large series support the notion that microsurgical removal of a brainstem cavernoma represents an effective therapy in experienced hands and is generally associated with good clinical outcome, both neurologically and in terms of QoL.
Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance...
Full Text Available Abstract Background Activation of the endothelium, complement activation and generation of cytokines are known events during ischemia-reperfusion (I/R that mediate tissue injury. Our aim was to elucidate their respective participation at the onset of the reperfusion phase. Tourniquet application in hand surgery causes short-term ischemia, followed by reperfusion and was therefore used as the model in this study. Methods Ten patients were included in the study after obtaining informed consent. A tourniquet was placed on the upper arm and inflated to 250 mmHg for 116 ± 16 min, during which the surgery was performed. Venous blood and tissue samples from the surgical area were taken at baseline as well as 0, 2, and 10 min after reperfusion and analyzed for the following parameters: Endothelial integrity and/or activation were analyzed by measuring heparan sulfate and syndecan-1 in serum, and vWF, heparan sulfate proteoglycan as well as CD31on tissue. Complement activation was determined by C3a and C4d levels in plasma, levels of C1-inhibitor in serum, and IgG, IgM, C3b/c, and C4b/c deposition on tissue. Cytokines and growth factors IL-5, IL-6, IL-7, IL-8, IL-10, IL-17, G-CSF, GM-CSF, MCP-1, TNFα, VEGF, and PDGF bb were measured in the serum. Finally, CK-MM levels were determined in plasma as a measure for muscle necrosis. Results Markers for endothelial activation and/or integrity as well as complement activation showed no significant changes until 10 min reperfusion. Among the measured cytokines, IL-6, IL-7, IL-17, TNFα, GM-CSF, VEGF, and PDGF bb were significantly increased at 10 min reperfusion with respect to baseline. CK-MM showed a rise from baseline at the onset of reperfusion (p Conclusions In this clinical model of I/R injury no damage to the endothelium, antibody deposition or complement activation were observed during early reperfusion. However, an increase of pro-inflammatory cytokines and growth factors was shown
Vara, Alexander D; Wu, John; Shin, Alexander Y; Sobol, Gregory; Wiater, Brett
Video recordings of surgical procedures are an excellent tool for presentations, analyzing self-performance, illustrating publications, and educating surgeons and patients. Recording the surgeon's perspective with high-resolution video in the operating room or clinic has become readily available and advances in software improve the ease of editing these videos. A GoPro HERO 4 Silver or Black was mounted on a head strap and worn over the surgical scrub cap, above the loupes of the operating surgeon. Five live surgical cases were recorded with the camera. The videos were uploaded to a computer and subsequently edited with iMovie or the GoPro software. The optimal settings for both the Silver and Black editions, when operating room lights are used, were determined to be a narrow view, 1080p, 60 frames per second (fps), spot meter on, protune on with auto white balance, exposure compensation at -0.5, and without a polarizing lens. When the operating room lights were not used, it was determined that the standard settings for a GoPro camera were ideal for positioning and editing (4K, 15 frames per second, spot meter and protune off). The GoPro HERO 4 provides high-quality, the surgeon perspective, and a cost-effective video recording of upper extremity surgical procedures. Challenges include finding the optimal settings for each surgical procedure and the length of recording due to battery life limitations. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I
BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10......,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before...... the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum...
Prakash, Jatin; Mehtani, Anil
Skeletal tuberculosis (TB) of the hand and wrist is rare, accounting for less than 1% of all osteoarticular TB. Although rare, TB of the hand and wrist is a cause of major morbidity. A common feature among all available reports on TB of the hand and wrist was a delay in diagnosis, causing residual stiffness and pain after treatment. Minimal initial symptoms, rarity of the lesion and ability of wrist TB to mimic more common pathologies account for the delay. Skeletal TB may behave differently in this age compared with the adult population. Further, the disease may affect the growing bone, causing residual deformities. The paucity of studies from different countries, coupled with a difficulty in diagnosis resulting in major morbidity, led us to carry out a study on this topic. A total of 44 patients with skeletal lesions in the hand and wrist were studied. The diagnosis was confirmed by biopsy. Patients were started on multidrug antitubercular treatment (ATT). Those not responding were scheduled for debridement. All patients were assessed using the Green O'Brian scoring system. All these patients were studied separately for clinical presentation, nutritional status (Rainey-Mcdonald nutritional index), time from onset of symptoms to presentation, treatment required, prognosis and complications. The proximal phalanx of the fourth digit and the metacarpal of the fifth digit were the most commonly involved bones in our series, with five cases of each. The capitate was the most common carpal bone, followed by the lunate. The duration of symptoms ranged from 5 weeks to 24 weeks (mean: 7.6 weeks). Most of these patients presented with complaints of pain, followed by swelling. 13 patients did not respond favourably to ATT over an 8-week period and were scheduled for surgery. Three of these patients had multidrug resistance. There was one case of a pathological fracture in our series and seven cases of arthritis/residual significant pain at the end of follow-up. For all the
Lastinger, Allison; Gomez, Kayeromi; Manegold, Ellen; Khakoo, Rashida
Patient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET. A cross-sectional survey was performed of hospitalized children's parents and adult patients in a 531-bed tertiary care teaching hospital in West Virginia. Surveys were anonymous and self-administered. A separate survey was administered via e-mail to resident and attending physicians from the departments of internal medicine, pediatrics, and family medicine. Most parents and adult patients felt it was their role to speak up if a provider did not perform hand hygiene, but a smaller number actually felt comfortable using the PET. Only 54.9% of physicians felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient to use words rather than the PET to remind them to perform hand hygiene. In our study, parents and adult patients supported use of the PET, but physicians were less supportive. As the patient empowerment movement grows, we should work to improve physician acceptance of patient involvement if it is to be successful. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Gretschel, Stephen; Estevez-Schwarz, Lope; Hünerbein, Michael; Schneider, Ulrike; Schlag, Peter M
To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; PPatient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.
Bunkenborg, Gitte; Bitsch Hansen, Tina; Hølge-Hazelton, Bibi
AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing...... and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety. DESIGN: An explorative, qualitative design using...... focused ethnography was applied to the study. METHODS: Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU...
To review nutritional supplements commonly required after bariatric surgery to provide a practical guide and reference source for generalist healthcare providers. A PubMed literature search (1988-July 2008) was conducted, using the search term nutritional deficiency after bariatric surgery, and was limited to English-language literature on adult (aged >19 y) human subjects. Additional references from the selected literature were also included. Data were extracted from large clinical series and practice guidelines whenever possible. Case reports were used only when they were the sole information source. Nutritional deficiencies that occur after bariatric surgery depend significantly on the type of surgery performed. Restrictive procedures such as gastric banding are the least likely to cause nutritional deficits, since none of the intestine is bypassed. Malabsorptive procedures such as biliopancreatic diversion or mixed restrictive/malabsorptive procedures (eg, Roux-en-Y gastric bypass) can result in serious nutritional problems when patients do not take required supplements after surgery. Vitamins and minerals that are commonly deficient in this circumstance include vitamin B(12), calcium, vitamin D, thiamine, folic acid, iron, zinc, and magnesium. Rare ocular complications have been reported with hypovitaminosis A. Healthcare professionals, especially those who practice outside large bariatric centers, must be aware of the supplements required by patients who have had bariatric surgery. Many patients fail to follow up with the surgery centers and are managed by their primary care teams and community pharmacists, especially in the selection of multivitamin and nutritional supplements.
Mutzbauer, Till S; Imfeld, Thomas
It has long been a standard procedure to replace coumarin by heparin if a patient using this oral anticoagulant had to undergo dental surgery. The Quick-Value had then to exceed a certain limit before surgery could be safely performed. Today this procedure has changed in that a switch to heparin is only made for invasive and large area surgery. Simple dental extractions, small biopsies and periodontal treatments are performed under continuous oral anticoagulation and local hemostyptic measures are applied. It has been shown that the likelihood of postoperative bleeding complications after adequate local hemostasis during dental surgery is much lower than is the risk of thrombosis or embolic complication following cessation of anticoagulant medication before surgery.
Rickers, Lisa; McSherry, Ciara
Nutritional deficiencies are common in patients who are obese and therefore individuals considering bariatric surgery may require dietary supplementation with multivitamins and minerals before surgery. Nutritional deficiencies following bariatric surgery are often proportional to the degree of malabsorption created by the surgical procedure or the extent of weight loss. Eating habits often contribute to nutritional deficiencies, so appropriate dietary and lifestyle counselling are essential following bariatric procedures to ensure appropriate macronutrient and micronutrient status. Nutritional supplementation following bariatric surgery commonly includes calcium with vitamin D, iron and vitamin B12 in addition to a daily multivitamin and mineral tablet. Although general guidelines exist, individual monitoring and tailoring are frequently required. This article provides an update of guidelines regarding the most common nutritional concerns and myths surrounding bariatric surgery.
Heydorn, Siri; Johansen, Jeanne Duus; Andersen, Klaus E
Fragrance allergy and hand eczema are both common among dermatological patients. Fragrance mix (FM) and its constituents have a recognized relevance to exposure to fine fragrances and cosmetic products. Based on extensive chemical analysis and database search, a new selection of fragrances...... was established, including 14 known fragrance allergens present in products to which hand exposure would occur. A non-irritating patch-test concentration for some fragrances was established in 212 consecutive patients. 658 consecutive patients presenting with hand eczema were patch tested with the European...... standard series and the developed selection of fragrances. 67 (10.2%) of the 658 patients had a positive reaction to 1 or more of our selection of fragrance chemicals present in the new selection. The most common reactions to fragrances not included in the FM were to citral, Lyral (hydroxyisohexyl-3...
This podcast is for hospital patients and visitors. It emphasizes two key points to help prevent infections: the importance of practicing hand hygiene while in the hospital, and that it's appropriate to ask or remind healthcare providers to practice hand hygiene. Created: 5/1/2008 by National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID). Date Released: 4/26/2010.
Johnson, Shepard P; Malay, Sunitha; Chung, Kevin C
To evaluate control group selection in nonrandomized studies published in the Journal of Hand Surgery American (JHS). We reviewed all papers published in JHS in 2013 to identify studies that used nonrandomized control groups. Data collected included type of study design and control group characteristics. We then appraised studies to determine whether authors discussed confounding and selection bias and how they controlled for confounding. Thirty-seven nonrandomized studies were published in JHS in 2013. The source of control was either the same institution as the study group, a different institution, a database, or not provided in the manuscript. Twenty-nine (78%) studies statistically compared key characteristics between control and study group. Confounding was controlled with matching, exclusion criteria, or regression analysis. Twenty-two (59%) papers explicitly discussed the threat of confounding and 18 (49%) identified sources of selection bias. In our review of nonrandomized studies published in JHS, papers had well-defined controls that were similar to the study group, allowing for reasonable comparisons. However, we identified substantial confounding and bias that were not addressed as explicit limitations, which might lead the reader to overestimate the scientific validity of the data. Incorporating a brief discussion of control group selection in scientific manuscripts should help readers interpret the study more appropriately. Authors, reviewers, and editors should strive to address this component of clinical importance. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
López López, Carlos Omar; Alvarez-Hernández, Everardo; Medrano Ramirez, Gabriel; Montes Castillo, Ma Luz; Hernández-Díaz, Cristina; Ventura Rios, Lucio; Arreguin Lopez, Roberto; Vázquez-Mellado, Janitzia
Rheumatic diseases have repercussions in hand function. The m-SACRAH (modified Score for the Assessment and quantification of Chronic Rheumatoid Affections of the Hands) questionnaire evaluates hand function according to the patient's opinion. Our aim was to look for the clinical and para-clinical variables that correlate with m-SACRAH in rheumatic diseases. Consecutive patients with diagnoses of rheumatoid arthritis (RA), osteoarthritis (OA), gout, and systemic sclerosis (SS) with hand involvement and who agreed to participate, answered the m-SACRAH and Health Assessment Questionnaire Disability Index (HAQ-DI) and underwent blinded and independent rheumatologist and physiatrist evaluations. Nerve conduction studies (NCS) and hand ultrasonography (USG) were performed. Spearman's correlation and the Mann-Whitney U-test. Forty patients were included. There were 72% women and mean age of 49.25 ± 14.2 years. According to m-SACRAH patients were dived into two groups (mild vs. moderate-severe), only the number limited to motion joints were different among them (median 2 vs. 8 P = 0.036). Patients' perspective variables had a good correlation (HAQ-DI/mSACRAH: r = 0.43, P hand function with physiatrist evaluations: passive range of motion (r = -0.49, P = 0.001), sum of affected pinches (r = 0.66, P = 0.001), limited to motion joints (r = 0.34, P < 0.05) and palm-finger distance (r = 0.50, P = 0.05). Regarding para-clinical evaluations, only tenosynovitis by ultrasonography correlated with HAQ-Di (r = 0.357, P < 0.05). Patients' perspectives correlated with the number of limited motion joints but with none of the other physicians' and para-clinical evaluations. The patients' opinion about their function should play a major role in their management. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Scully, Crispian; Wolff, Andy
Surgery is the main oral healthcare hazard to the patient with a bleeding tendency, which is mostly caused by the use of anticoagulants. The traditional management entails the interruption of anticoagulant therapy for dental surgery to prevent hemorrhage. However, this practice may increase the risk of a potentially life-threatening thromboembolism. Because this issue is still controversial, it is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients on the 3 main types of anticoagulants: coumarins, heparins, and aspirin. MATERIALS REVIEWED: The pertinent literature and clinical protocols of hospital dentistry departments have been extensively reviewed and discussed. Several evolving clinical practices in the last years have been detected: anticoagulant use is generally not discontinued; oral surgery is performed despite laboratory values showing significant bleeding tendency; new effective local methods are used to prevent bleeding; and patients at risk are referred to hospital-based clinics. The management of oral surgery procedures on patients treated with anticoagulants should be influenced by several factors: extent and urgency of surgery, laboratory values, treating physician's recommendation, available facilities, dentist expertise, and patient's oral, medical, and general condition.
Salman Al Sabah
Conclusion: Bariatric surgery is a safe and effective procedure to assist renal transplant patients in losing weight. In addition, it has proven to be effective in the management of the co-morbidities that are associated with renal failure. Our study was also able to prove that converting form an SG to a bypass in a transplant patient is a safe and feasible option.
García Duque, S; Pérez Segura, G; Sanavia Morán, E; de Juanes Pardo, J R; Arrazola Martínez, Ma P; Resines Erasun, C
.... Tertiary hospital, Clinical Nutrition Unit. 107 patients (56.1% women, 43.9% men, 62.1 +/- 20.4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis...
Zhang, Xubing; Wu, Qingbin; Gu, Chaoyang; Hu, Tao; Bi, Liang; Wang, Ziqiang
This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) and conventional open surgery (OS) for colorectal cancer (CRC) in terms of intraoperative and postoperative outcomes, and to explore the safety, feasibility of HALS for CRC surgery. A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on April 23, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, length of postoperative hospital stay, time to first flatus, time to first liquid diet, time to first soft diet, time to first bowel movement, postoperative complications, reoperation, ileus, anastomotic leakage, wound infection, urinary complication, pulmonary infection, and mortality). Fifteen articles published between 2007 and 2017 with a total of 1962 patients with CRC were included in our meta-analysis. HALS was associated with longer operative time, less blood loss, smaller length of incision, shorter hospital days and postoperative hospital days, less time to first flatus, less wound infection, and less postoperative complications. There was no difference in blood transfusion, lymph node harvested, time to first liquid or soft diet, time to first bowel movement, reoperation, ileus, anastomotic leakage, pulmonary infection, urinary complications, or mortality. Our meta-analysis suggests that HALS in CRC surgery improves cosmesis and results in better postoperative recovery outcomes by reducing postoperative complications and hospital days. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those 2 techniques for CRC treatment.
Full Text Available This paper presents a methodology for movement recognition in hand-assisted laparoscopic surgery using a textile-based sensing glove. The aim is to recognize the commands given by the surgeon’s hand inside the patient’s abdominal cavity in order to guide a collaborative robot. The glove, which incorporates piezoresistive sensors, continuously captures the degree of flexion of the surgeon’s fingers. These data are analyzed throughout the surgical operation using an algorithm that detects and recognizes some defined movements as commands for the collaborative robot. However, hand movement recognition is not an easy task, because of the high variability in the motion patterns of different people and situations. The data detected by the sensing glove are analyzed using the following methodology. First, the patterns of the different selected movements are defined. Then, the parameters of the movements for each person are extracted. The parameters concerning bending speed and execution time of the movements are modeled in a prephase, in which all of the necessary information is extracted for subsequent detection during the execution of the motion. The results obtained with 10 different volunteers show a high degree of precision and recall.
Benjamin H Miranda
Full Text Available BackgroundInsufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria.MethodsPatients (250 were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma, underlying issue (functional/symptomatic vs. cosmetic and revision surgery details were also collected with the added use of a real-time, hospital database.ResultsTelephone contacting was achieved for 211 patients (214 scar revisions. Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016 and by females vs. males (85.52% vs. 75.36%, P<0.05, particularly in the elective group where males (36.17% were more likely to report no change or worse outcomes versus females (16.04% (P<0.01.ConclusionsSuccessful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision.
Kaluga, Elżbieta; Kostiukow, Anna; Samborski, Włodzimierz; Rostkowska, Elżbieta
Clinical symptoms of rheumatic diseases can cause changes in the level of skin tactile sensitivity. To determine the tactile threshold of the hands in female patients with rheumatic diseases. It also attempted to determine correlations between rheumatic patients' tactile sensitivity and the degree of articular movement limitations, the Barthel Index (BI) and Edinburgh Handedness Inventory (EHI) results, the level of disability of the right hand and the left hand as well as age, education and eyesight. Ninety-nine female rheumatic patients aged 19-87 years took part in the study. The control group comprised 45 healthy women aged 23-80 years. The measurement of the tactile threshold was performed using the Touch-Test™ Sensory Evaluators (Semmes-Weinstein Monofilaments Test). The tactile threshold was measured at three sites on the hand: the little finger, the index finger and the metacarpus. The patients' tactile sensitivity ranges were classified as normal, diminished light touch and diminished protective touch. The degree of their disability was correlated with tactile sensitivity. The patients' tactile sensitivity worsens with age, but it is not correlated with the level of education. The lateralization was similar to that of the control group and was not correlated with tactile sensitivity. The worsening eyesight, independent of rheumatic disease, corresponds, however, with decreasing tactile sensitivity. The patients represented a group with a medium level of functional disability and lower tactile sensitivity.
Hruby, Laura A; Sturma, Agnes; Mayer, Johannes A; Pittermann, Anna; Salminger, Stefan; Aszmann, Oskar C
OBJECTIVE Global brachial plexus lesions with multiple root avulsions are among the most severe nerve injuries, leading to lifelong disability. Fortunately, in most cases primary and secondary reconstructions provide a stable shoulder and restore sufficient arm function. Restoration of biological hand function, however, remains a reconstructive goal that is difficult to reach. The recently introduced concept of bionic reconstruction overcomes biological limitations of classic reconstructive surgery to restore hand function by combining selective nerve and muscle transfers with elective amputation of the functionless hand and its replacement with a prosthetic device. The authors present their treatment algorithm for bionic hand reconstruction and report on the management and long-term functional outcomes of patients with global brachial plexopathies who have undergone this innovative treatment. METHODS Thirty-four patients with posttraumatic global brachial plexopathies leading to loss of hand function consulted the Center for Advanced Restoration of Extremity Function between 2011 and 2015. Of these patients, 16 (47%) qualified for bionic reconstruction due to lack of treatment alternatives. The treatment algorithm included progressive steps with the intent of improving the biotechnological interface to allow optimal prosthetic hand replacement. In 5 patients, final functional outcome measurements were obtained with the Action Arm Research Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS In all 5 patients who completed functional assessments, partial hand function was restored with bionic reconstruction. ARAT scores improved from 3.4 ± 4.3 to 25.4 ± 12.7 (p = 0.043; mean ± SD) and SHAP scores improved from 10.0 ± 1.6 to 55 ± 19.7 (p = 0.042). DASH scores decreased from 57.9 ± 20.6 to 32 ± 28.6 (p = 0.042), indicating decreased disability. CONCLUSIONS The authors
S. Visal Buturak
Full Text Available Purpose: It has been known that psychological factors have an important effect on the decision to undergo aesthetic surgery. In this study, we aimed to test the hypothesis that the personality traits of people admitted for aesthetic surgery differ from those of people who have never planned to undergo aesthetic surgery in their lives. Material and Methods: Forty-seven patients who were referred to the outpatient clinic of the Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Kirikkale University to undergo aesthetic surgery were enrolled in the study. Forty-three subjects who neither underwent nor planned to undergo aesthetic surgery at any time in their lives were included in the study as a control group. Psychometric evaluation of the patients and the control group was conducted using the Turkish version of the Minnesota Multiphasic Personality Inventory (MMPI. Results: Taking 65 as a cut-off point, the ratio of patients who scored and #8805;65 on the hysteria subscale of the MMPI was found to be significantly higher in the sugery group than in the control group and the ratio on social introversion subscale was also higher in the patient group than in the control group, very closely approaching significance. Conclusion: It should be kept in mind that people who have personality traits that can be partially improved with psyachiatric treatment, such as social introverted, lonely, timid, shy, and hysterical and feel the need for validation by others, may be more often admitted for aesthetic surgery. [Cukurova Med J 2016; 41(3.000: 554-558
Desserud, K F; Veen, T; Søreide, K
Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
Zaragoza-Lemus, Guadalupe; Hernández-Gasca, Verónica; Espinosa-Gutiérrez, Alejandro
Continuous perineural infusion of local anesthetic provides better postoperative analgesia than intravenous administration of opioids or NSAIDs in upper limb surgery. The infraclavicular approach is a good option due to the muscular stability to catheter; the abduction of the arm apparently makes more superficial the brachial plexus and which elevates clavicle cephalad. The aim of this study was to identify whether the abduction of the arm for to decreases the skin-plexus distance, facilitating it catheter insertion in a perineural way for a better analgesia. This relation between the arm and the colocation of catheter has not yet been established. We included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. It was placed continuous infraclavicular block guided by ultrasound, it allow the catheter tip was adjacent to the posterior cord. In the group patients with high technical difficulties were allowed to reposition the arm abduction, recording number of punctures, redirects, ease of insertion of the catheter and skin-plexus distance. The abduction of the arm moved the clavicle toward cephalad and separated it from the linear transducer, this allowed to maneuver the needle right angle and redirect it, the distance skin-plexus did not decrease significantly with arm position. Arm abduction allows better scanning facilitates the infraclavicular puncture and catheter introduction. Copyright © 2015. Published by Masson Doyma México S.A.
Iskandar, H; Rakotondriamihary, S; Dixmérias, F; Binje, B; Maurette, P
To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). Prospective, randomized study. Forty-two ASA physical class 1 and 2 patients were enrolled over a twelve-month period and randomly allocated either into the CA or the PCA group. After recovery from the surgical block, the axillary plexus was located using a nerve stimulator and a 20 G catheter (Contiplex B Braun) inserted over 5 centimeters into the axillary sheath. In the CA group (n = 21) patients received 0.1 mL.kg-1.h-1 of 0.25% bupivacaine and in the PCA group (n = 21) patients received 0.1 mL.kg-1 boluses of 0.25% bupivacaine with a one hour lock-out period. Data collected were pain intensity rated according to he visual analog scale (VAS), the total volume of bupivacaine injected, the quantity of nalbuphine administered as 10 mg boluses when VAS was = 5, and the patient's satisfaction after removal of the catheter. Statistical analysis used Student t test, ANOVA and chi 2 test. The mean duration of catheter use was 5 +/- 3 days. During this period the amount of bupivacaine was significantly reduced in the PCA group when compared to the CA group (P plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.
Sears, Erika Davis; Larson, Bradley P; Chung, Kevin C
We assessed hand surgery program directors' opinions of essential components of hand surgery training and potential changes in the structure of hand surgery programs. We recruited all 74 program directors of Accreditation Council of Graduate Medical Education-accredited hand surgery fellowship programs to participate. We designed a web-based survey to assess program directors' support for changes in the structure of training programs and to assess opinions of components that are essential for graduates to be proficient. Respondents were asked to rate 9 general areas of practice, 97 knowledge topics, and 172 procedures. Each component was considered essential if 50% or more of respondents thought that graduates must be fully knowledgeable of the topic and be able to perform the procedure at the end of training. The response rate was 84% (n = 62). A minority of program directors (n = 15; 24%) supported creation of additional pathways for hand surgery training, and nearly three-quarters (n = 46; 74%) preferred a fellowship model to an integrated residency model. Most program directors (n = 40; 65%) thought that a 1-year fellowship was sufficient to train a competent hand surgeon. Wrist, distal radius/ulna, forearm, and peripheral nerve conditions were rated as essential areas of practice. Of the detailed components, 76 of 97 knowledge topics and 98 of 172 procedures were rated as essential. Only 48% respondents (n = 30) rated microsurgery as it relates to free tissue transfer as essential. However, small and large vessel laceration repairs were rated as essential by 92% (n = 57) and 77% (n = 48) of respondents, respectively. This study found resistance to prolonging the length of fellowship training and introduction of an integrated residency pathway. To train all hand surgeons in essential components of hand surgery, programs must individually evaluate exposure provided and find innovative ways to augment training when necessary. Studies of curriculum content in hand
Shrivastava, Anurag; Madu, Assumpta; Schultz, Jeffrey
Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
Wheeler, Patrick; Boyd, Kevin; Shipton, Mary
Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures. Results: Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time. Conclusion: Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies. PMID:26535314
Heydorn, Siri; Johansen, Jeanne Duus; Andersen, Klaus E
Fragrance allergy and hand eczema are both common among dermatological patients. Fragrance mix (FM) and its constituents have a recognized relevance to exposure to fine fragrances and cosmetic products. Based on extensive chemical analysis and database search, a new selection of fragrances was es...
R. Sh. Saitgareev
Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies
Kucewicz-Czech, Ewa; Kiecak, Katarzyna; Urbańska, Ewa; Maciejewski, Tomasz; Kaliś, Robert; Pakosiewicz, Waldemar; Kołodziej, Tadeusz; Knapik, Piotr; Przybylski, Roman; Zembala, Marian
Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009-2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients. The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality). The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium.
Full Text Available Rheumatoid arthritis (RA often results in impairments in upper extremities, especially in the small joints of hand. Involvement of hand brings limitations in activities of daily living. However, it is commonly observed that patient-reported functional status of hand does not always corresponds to their actual physical performance in the clinical setting. The aim of this pilot study is to investigate the relationship between patient self-reported and objectively measured hand functions in patients with RA. Twenty-six patients (51±13 years with RA diagnosis participated in the study. Hand grip and pinch (lateral, bipod, tripod strengths were measured and Jebsen Hand Function Test (JHFT was performed for objective functional performance. Duruöz Hand Index and Beck Depression Inventory - Turkish version were completed by patients. Grip and all three-pinch strength results significantly correlated with Duruöz Hand Index scores (p<0.05. JHFT results except the sentence writing also correlated with the Duruöz scores (p<0.05. Our results showed that self-reported outcome scales might be used for determining functional level of hand in patients with RA in rheumatology practice. Objective quantitative functional tests are the best methods in evaluating functional level of hand, but require valid and reliable equipment with accurate calibration. Therefore, in case of unavailability of objective assessment tools, patient-reported scales may also reflect the real status of hand functions.
Background: Dacryocystorhinostomy (DCR) is widely accepted as the procedure of choice for surgical correction of lacrimal drainage system obstruction distal to common canaliculus in adulthood. Although, there are only limited epidemiological data available in Iran about the patients undergoing DCR surgery. Aim: This ...
known fact that satisfied patients are an asset to the service as they can promote the service and encourage others to accept surgery.This study found a high level of .... REFERENCES. 1. Resnikoff S, Pascolini D, Etya'ale D, Kocur. I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year. 2002.
Chew, Ming Tak; Sandham, John; Soh, Jen; Wong, Hwee Bee
Objective: To evaluate the outcome of orthognathic surgery by objective cephalometric measurement of posttreatment soft-tissue profile and by subjective evaluation of profile esthetics by laypersons and clinicians. Materials and Methods: The sample consisted of 30 Chinese patients who had completed
Shenefelt, Philip D
Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries.
Kufta, Kenneth; Peacock, Zachary S; Chuang, Sung-Kiang; Inverso, Gino; Levin, Lawrence M
The purpose of this study was to compare overall patient satisfaction after orthognathic surgery with the following specific categories: appearance, functional ability, general health, sociability, and patient-clinician communication. A 16-question survey was developed and administered to include patients at either 6 or 12 months after orthognathic surgery between June 2013 and June 2014 at the University of Pennsylvania and Massachusetts General Hospital. The predictor variables included age, sex, type of procedure, medical comorbidities, intra- or postoperative complications, and presence of paresthesia. The outcome variable was patient satisfaction overall and in each category based on a Likert scale (0: not satisfied at all to 5: very satisfied).A total of 37 patients completed the survey and had a high overall rate of satisfaction (100% of responses were 4 or 5 on Likert scale). Overall satisfaction had the highest correlation with appearance (ρ=0.52, P=0.0009) followed by sociability (ρ=0.47, P=0.004), patient-clinician communication (ρ=0.38, P=0.02) functionality (ρ=0.19, P=0.26), and general health (ρ = -0.11, P = 0.51). Patients had high satisfaction scores for orthognathic surgery. Satisfaction with postoperative appearance had the strongest correlation with overall satisfaction.
Wehrli, Martina; Hensler, Stefanie; Schindele, Stephan; Herren, Daniel B; Marks, Miriam
The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ. Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined. The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and -0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points. Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture. The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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Pokharel, Krishna; Bhattarai, Balkrishna; Tripathi, Mukesh; Khatiwada, Sindhu; Subedi, Asish
To determine the changes in anxiety level and need for information at three different time points before surgery. Prospective observational study. Ward (T(1)), preoperative holding area (T(2)), and operating room (T(3)) of a university hospital. 201 adult, ASA physical status 1 and 2 patients scheduled for elective operations. Level of anxiety and need for information about surgery and/or anesthesia were assessed with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) three times before the start of surgery: in the ward, the preoperative holding area, and the operating room. The psychometric characteristics of the APAIS were similar to its original Dutch version. The frequency of patients with high preoperative anxiety peaked at the preoperative holding area. The median score on need for information decreased from T(1) [4; interquartile range (IR) 2-5] to T(2) (3; IR 2-4) (P anxiety scores for anesthesia were significantly (P information about their surgical procedure was significantly (P information also were more anxious (P anxiety were female gender [odds ratio (OR) 4; 95% confidence interval (CI) 1.09-14.94] and need for general anesthesia (OR 7.1; 95% CI 0.93-54.98). The characteristics, general anesthesia (OR 3.3; 95% CI 1.1-10.0), younger age (≤ 30 yrs; OR 2.9; 95% CI 1.3-6.4), education (>12 yrs; OR 2.6; 95% CI 1.2-5.4), and no previous surgery (OR 2.6; 95% CI 1.2-5.5), correlated with greater need for information. The frequency of anxious patients is variable at different time points before surgery. The factors correlating with anxiety before surgery are nonmodifiable. Providing information to those individuals is the only modifiable option. Copyright © 2011 Elsevier Inc. All rights reserved.
Devereaux, P J; Sessler, Daniel I; Leslie, Kate
to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1...... surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT...
Yeslev, Max; Gupta, Varun; Winocour, Julian; Shack, R Bruce; Grotting, James C; Higdon, K Kye
Limited surgical literature currently exists that evaluates postoperative complications after cosmetic surgery in adolescents. The purpose of this study was to determine the incidence of major postoperative complications in adolescent patients undergoing cosmetic surgery and compare their complication rates to older patients. A prospective cohort of patients undergoing cosmetic surgical procedures between 2008 and 2013 was identified from the CosmetAssure database. Demographics, clinical characteristics, surgical procedures, and major complications in adolescent patients (age 10-19 years) and older patients (≥20 years old) were compared. Risk factors analyzed included age, gender, body mass index, smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Overall, 3519 adolescents and 124,409 older patients underwent cosmetic surgical procedures. The adolescent cohort contained more men (20.0% vs 6.0%, P cosmetic procedures. Adolescent patients had lower complications rates after face, breast, and body procedures compared to the older cohort. The most common postoperative complications in adolescent patients were hematoma (0.34%) and infection (0.28%). Cosmetic surgical procedures in adolescent patients are safe with a lower rate of major postoperative complications compared to older patients. 2.
Forer, Yaara; Block, Colin; Frenkel, Shahar
The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods. Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands. Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.
Sorice, Sarah C; Li, Alexander Y; Gilstrap, Jarom; Canales, Francisco L; Furnas, Heather J
Many plastic surgeons use social media as a marketing tool to attract and retain patients, but information about how patients use social media and their preferred types of plastic surgery posts have been lacking. To investigate patients' preferred social media networks and the type of posts they wished to see, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons by surveying 100 consecutive patients. The age of the patients averaged 44.4 years (range, 17 to 78 years). Facebook had the greatest patient use and engagement, with YouTube second in use, and Instagram second in number of engaged users. Over half used Pinterest, but with little daily engagement. Only one-fourth used Snapchat, but the percentage of users who were highly engaged was second only to Facebook. The least popular network was Twitter, with the fewest patient users and least engagement. Social media played a minor role compared with the practice's Web site in both influencing patients to choose the practice and providing information on the day of the appointment. Patients most wanted to see posts on a plastic surgeon's social media platform related to practice information, before-and-after photographs, and contests. Articles about plastic surgery held the least interest. Among five types of Web site content, patients expressed most interest in before-and-after photographs. This study is the first to articulate the plastic surgery patient perspective regarding social media. The findings aim to help plastic surgeons maximize their influence on their target audience.
Forstmeier, V; Sorg, H; Kabbani, M; Herold, C; Altintas, M A; Krämer, R
Cutaneous microcirculation has shown to play a key role in wound healing. Although healing disorders are still one of the most common complications in hand surgery, there still exists a lack of scientific research on possible age-related changes in cutaneous microcirculation at the dorsum of hand. Cutaneous microcirculation at the dorsum of the hand differs significantly between different age groups. 53 healthy subjects were divided into 2 groups by age (Group A:Group B≥40 years, n=22). All subjects underwent measurement of the microcirculation at the dorsum of the hand with combined laser-Doppler and photo spectrometry. Cutaneous oxygen saturation was significantly higher in Group A than in Group B (A: 64.7±9.9% vs. B: 58.3±12.6%; p=0,044). In contrast, blood flow velocity was significantly higher in Group B (A: 43±19.6 AU vs. B: 56.7±21.1 AU; p=0.019). The hypothesis of this study was confirmed. This is the first study to show significant differences of cutaneous microcirculation at the dorsum of the hand within different age groups. Further clinical trials are needed in order to examine if delayed wound healing can be correlated to impaired cutaneous microcirculation at the dorsum of the hand. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available This study aims to evaluate and to compare three different approaches of cataract surgery to patients with previous radial keratotomy (RK, and to analyze the mechanical properties of the cornea after cataract surgery. Three groups of patients, each one including 8 eyes of patients with 16 RK incisions. The first group includes eyes with the first cataract incision superiorly, the second group in the temporal area, the third group in temporal area and a precautionary stabilizing suture across the RK incision adjacent to the main tunnel. In the first group intraoperative dehiscence occurred in three eyes (37.5%: it required immediate application of a suture. In the second group dehiscence occurred intraoperatively in two radial scars (20%: it required immediate application of a suture. In the third group, no intraoperative dehiscences were observed. The stabilizing suture of the RK incision works safer, with a lower risk of dehiscences and less post-operative astigmatism.
Meduri, Alessandro; Urso, Mario; Signorino, Giuseppe A.; Rechichi, Miguel; Mazzotta, Cosimo; Kaufman, Stephen
This study aims to evaluate and to compare three different approaches of cataract surgery to patients with previous radial keratotomy (RK), and to analyze the mechanical properties of the cornea after cataract surgery. Three groups of patients, each one including 8 eyes of patients with 16 RK incisions. The first group includes eyes with the first cataract incision superiorly, the second group in the temporal area, the third group in temporal area and a precautionary stabilizing suture across the RK incision adjacent to the main tunnel. In the first group intraoperative dehiscence occurred in three eyes (37.5%): it required immediate application of a suture. In the second group dehiscence occurred intraoperatively in two radial scars (20%): it required immediate application of a suture. In the third group, no intraoperative dehiscences were observed. The stabilizing suture of the RK incision works safer, with a lower risk of dehiscences and less post-operative astigmatism. PMID:28730124
Heydorn, Siri; Johansen, Jeanne Duus; Andersen, Klaus E
Fragrance allergy and hand eczema are both common among dermatological patients. Fragrance mix (FM) and its constituents have a recognized relevance to exposure to fine fragrances and cosmetic products. Based on extensive chemical analysis and database search, a new selection of fragrances......-cyclohexene carboxaldehyde) and oxidized l-limonene. A concomitant reaction to the FM identified potential fragrance allergy in less than (1/2) of these patients. Exposure assessment and a statistically significant association between a positive patch test to our selected fragrances and patients' history...
Hao, Long; Long, Jiang; YongBin, Lin; DongRong, Situ; Yan, Zheng; YiGong, Zhang; GuoWei, Ma
Hand-Assisted Thoracoscopic Surgery for pulmonary metastasectomy through sternocostal triangle access allows manual palpation of both lungs, thus permitting effective treatment of lung metastases. In our research, 62 patients from November 2001 to January 2012 underwent our Hand-Assisted Thoracoscopic Surgery procedures for pulmonary metastasectomy. Clinical data, including the number of pulmonary metastases determined by Computed Tomography/Positron Emission Tomography-Computed Tomography, surgical findings and survival data of these patients were collected. We found that the median follow-up time was 23.7 months (range 2.4 to 85.6 months). 30 cases of them had post-operative recurrences and the median disease-free survival period was 27.4 months. For Computed Tomography scan, the overall sensitivity for proved metastases was 63% (115/182). 67 non-imaged malignant nodules were palpated and removed in 14 cases. For Positron Emission Tomography-Computed Tomography scan, the overall sensitivity was 66% (79/120). 41 non-imaged malignant nodules were palpated and removed in 12 cases. This study show that the Hand-Assisted Thoracoscopic Surgery provides an easier way for routine bilateral pleural exploration, and thus is critical and effective in detection of non-imaged malignant pulmonary metastases, which might contribute to long-term disease-free survival.
Liu, Rani; Damman, Wendy; Kaptein, Adrian A; Rosendaal, Frits R; Kloppenburg, Margreet
Coping responses have been shown to determine health outcomes in chronic diseases. The aim of the study was to examine the role of joint-specific factors and coping styles on disability in patients with hand OA. Primary hand OA patients who consulted secondary care, underwent physical examination to assess the number of joints with bony joint enlargements, pain upon palpation, soft tissue swelling, deformities and limitations in motion. Coping styles were assessed with Coping with Rheumatic Stressors. Disability (score ≥5) was assessed by the Functional Index for Hand OA (possible score 0-30) cross-sectionally and after 1 year. With multivariate logistic regression, joint-specific variables and coping styles were associated with disability cross-sectionally and after 1 year, adjusted for age, sex and BMI. A total of 314 patients (88% women, mean age 61.4 years) were included in the cross-sectional analyses; 68% were considered as disabled. Longitudinal data after 1 year were available in 173 patients (71% disabled). In multivariate analysis including all joint-specific factors, only painful joints and joints with limitations in motion were associated with disability. Disadvantageous scores for the coping scales (comforting cognitions, decreasing activity and pacing) were positively associated with disability cross-sectionally. Disability after 1 year was only associated with the coping scales decreasing activity and pacing. Joint-specific factors were also associated with disability, independent of coping styles. In patients with hand OA, joint-specific factors and coping styles decreasing activity and pacing were both associated with disability. Our results suggest that interventions should aim at joint-specific complaints as well as changing coping styles to improve functional outcome. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: email@example.com.
Sang, Hongqiang; Wang, Shuxin; Li, Jianmin; He, Chao; Zhang, Lin'an; Wang, Xiaofei
Compared with conventional minimally invasive surgery and open surgery, robotic-assisted minimally invasive surgery can overcome or eliminate drawbacks caused by operator restrictions, motion limitation by the trocar and the image system, such as fatigue, trembling, low precision, constrained degree-of-freedom, poor hand-eye coordination and restricted surgical vision. In this paper, a novel partly tendon-driven master-slave robot system is proposed to assist minimally invasive surgery and a master-slave control architecture is developed for abdominal surgical operations. A novel master-slave surgery robot system named MicroHand A has been developed. A kinematic analysis of master and slave manipulators was conducted, based on screw theory and vector loop equation. The relationships of the tendon-driven multi-DOF surgical instrument among Cartesian space, actuator space and joint space were derived for control purposes. The control system architecture of the MicroHand A was designed with intuitive motion control and motion scaling control. Llewellyn's absolute stability criterion and the transparency of the one-DOF master-slave system are also analysed. Intuitive motion control under dissimilar kinematics in master-slave manipulations and motion scaling control were accomplished to solve absonant hand-eye coordination, kinematic dissimilarity and workspace mismatch of master-slave manipulator problems. A series of tests and animal experiments were carried out to evaluate system performance. The experimental results demonstrate that the system could accomplish intuitive motion control and motion scaling control, and that the control system is stable and reliable. The experiments performed on the MicroHand A robotic system yielded expected control results. The system satisfies the requirements of minimally invasive surgery. Intuitive motion control and motion scaling control under different kinematics for the master and slave have been implemented. Copyright © 2011
Elmore, Jasmine R; Priest, James H; Laskin, Daniel M
Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.
Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard
To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....
Sunkesula, Venkata C K; Kundrapu, Sirisha; Knighton, Shanina; Cadnum, Jennifer L; Donskey, Curtis J
We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients' hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2017;38:595-597.
Hallock, Jennifer L; Rios, Rebeca; Handa, Victoria L
Informed consent is a process that necessitates time and effort. Underlying this investment is the belief that informing patients about the surgery promotes patient satisfaction with the decision for surgery and potentially satisfaction more broadly. The objective of the study was to investigate the extent to which preoperative satisfaction with a decision to pursue surgery is associated with understanding after an informed consent discussion. We performed an observational study of adult women seeking surgical treatment for pelvic floor disorders. Study participants were recruited after routine preoperative counseling by board-certified or board-eligible urogynecologists. In our practice, the preoperative informed consent process typically includes a discussion of the indications, risks, benefits, alternatives, and chance of success of the procedures. Participants completed a 35 question survey preoperatively at one setting. The primary outcome, satisfaction with decision, was measured with a validated 6 item Satisfaction with Decision Scale-Pelvic Floor Disorder. Participants were classified as highly satisfied if they indicated the highest level of satisfaction for all items. The primary exposure was patient knowledge of the planned surgery, measured using a newly adapted 20 item Informed Consent Questionnaire including 15 yes/no questions and 5 free-text questions. Additionally, the survey included a validated 3 item tool for health literacy, a single-item anxiety measure, and demographic data. Analyses were performed with a χ2 test, a Student t test, and a multivariable logistic regression using the binary outcome variable, highly satisfied or not highly satisfied. A total of 150 participants were enrolled, with a mean age of 57.5 years. The majority were non-Hispanic (97.3%) or white (87.3%), with at least some college education (51.0%). The median number of days between the informed consent discussion and the survey was 35. The mean total Satisfaction with
Bariatric surgery is currently the most effective method of sustainable weight loss among morbidly obese patients. The types of bariatric surgeries can be divided into three categories: restrictive procedures, malabsorptive procedures, and combination (restrictive and malabsorption) procedures. In general, patients undergoing restrictive procedures have the least risk for long-term diet-related complications, whereas patients undergoing malabsorptive procedures have the highest risk. For many patients, the benefits of weight loss, such as decreased blood glucose, lipids, and blood pressure and increased mobility, will outweigh the risks of surgical complications. Most diet-related surgical complications can be prevented by adhering to strict eating behavior guidelines and supplement prescriptions. Eating behavior guidelines include restricting portion sizes, chewing foods slowly and completely, eating and drinking separately, and avoiding foods that are poorly tolerated. Supplement prescriptions vary among practitioners and usually involve at least a multivitamin with minerals. Some practitioners may add other supplements only as needed for diagnosed deficiencies; others may prescribe additional prophylactic supplements. The most common nutrient deficiencies are of iron, folate, and vitamin B12. However, deficiencies of fat-soluble vitamins have been reported in patients with malabsorption procedures, and thiamin deficiency has been reported among patients with very poor intake and/or nausea and vomiting. Frequent monitoring of nutrition status for all patients can aid in preventing severe clinical deficiencies.
Joshua M. Abzug
Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .
Sachse, Florian; Stoll, Wolfgang
Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener's granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.
Kung, Jennifer S.; Daniel Y Choi; Cheema, Anjum S.; Kuldev Singh
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-es...
Franck, Johan Anton; Smeets, Rob Johannes Elise Marie; Seelen, Henk Alexander Maria
Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated. This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge. Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation. A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies.
This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…
The aim of this thesis was to investigate the limitations in daily life, outcome measures, clinical outcomes with the emphasis on patient satisfaction, and economic aspects of the treatment of hand osteoarthritis (OA). Patients with hand OA report severe restrictions in daily life, in particular in
Rai, Herleen; Knighton, Shanina; Zabarsky, Trina F; Donskey, Curtis J
We conducted a randomized trial of a simple educational intervention encouraging patients to perform hand hygiene at 5 specific moments, including on entry of health care personnel into their room as a reminder of the importance of hand hygiene. The intervention resulted in a significant increase in patient hand hygiene. Published by Elsevier Inc.
Pinto, Andressa dos Santos; Grigoletti, Shana Souza; Marcadenti, Aline
The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO, EMBASE and Cochrane, without time restriction. Were used the descriptors: "preoperative fasting", "cancer", "diet restriction" and "perioperative period". Randomized trials were included in adults of both sexes, with diagnosis of cancer. Exclusion criteria were: use of parenteral nutrition and publications in duplicate. All analyzes, selections and data extraction were done blinded manner by independent evaluators. Four studies were included, with a total of 150 patients, 128 with colorectal cancer and 22 gastric cancer. The articles were published from 2006 to 2013. The main outcome measures were heterogeneous, which impaired the unification of the results by means of meta-analysis. Compared to traditional protocols, patients undergoing fasting abbreviation with the administration of fluids containing carbohydrates had improvements in glycemic parameters (fasting glucose and insulin resistance), inflammatory markers (interleukin 6 and 10) and indicators of malnutrition (grip strength hand and CRP/albumin ratio), and shorter hospital stay. The methodological quality of the reviewed articles, however, suggests that the results should be interpreted with caution. The abbreviation of perioperative fasting in patients with neoplasm appears to be beneficial.
Full Text Available Abstract Background Epithelioid sarcomas of the hand are rare, high-grade tumors with a propensity for regional lymphatic spread approaching 40%. Case presentation A 54-year-old male with an epithelioid sarcoma of the palm was treated with neoadjuvant radiation, wide excision, and two-stage reconstruction. Sentinel lymph node biopsy was used to stage the patient's axilla. Sentinel node biopsy results were negative. The patient has remained free of local, regional and distant disease for the follow-up time of 16 months. Conclusion The rarity of this tumor makes definitive conclusions difficult but SLN biopsy appears to be a useful adjunct in the treatment of these sarcomas.
Pajares, A; Larrea, L; Zarragoikoetexea, I; Tur, A; Vicente, R; Argente, P
The main objective of the study was to evaluate the effect of implementing a blood-saving programme in patients undergoing elective cardiac surgery with an analysis of the transfusion rate and complications. A single-centre, observational, retrospective, comparative study which included 604 consecutive patients older than 15 years old undergoing elective cardiac surgery. Two groups of patients were created according to whether or not they were included in a blood-saving protocol, and analysed between December 2012 and July 2013 (293 patients, prep group) and April 2015 to May 2016 (311 patients, posp group). The overall blood product transfusion rate was reduced in the posp group (89.5 vs. 67.6%; P<0.001), as well as individually: red blood cell concentrates (83.6%; P<0.001), fresh frozen plasma (36.2 vs. 21.2%; P<0.001), platelets (40.8 vs. 32.7; P<0.001). By contrast, fibrinogen use increased from 16.4 to 49% (P<0.001). Postoperative complications were similar in both groups, except for pulmonary complications (57.8 vs. 43.1%; P<0.001). Length of hospital stay was similar in both groups except in the Critical Care Unit with longer stay for the prep group (5.81±8.00 vs. 4.18±4.38; P=0.002). Mortality did not change. The implementation of a blood-saving programme in the cardiac surgery area has favourable consequences, such as a saving in blood product and a reduction of pulmonary complications, although without decreasing the mortality rate. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
Bolanowski, Marek; Pluskiewicz, Wojciech; Adamczyk, Piotr; Daroszewski, Jacek
The aim of this study was assessment of skeletal status using quantitative ultrasound (QUS) at hand phalanges in patients with acromegaly. A group of 38 patients with acromegaly (27 women and 11 men) with a mean age of 57.21 +/- 9.85 years was compared with a control group of 44 men and 108 women matched for gender, age and body size. Amplitude-dependent speed of sound (Ad-SoS) at hand phalanges had lower values in patients with acromegaly than in controls, both in the entire group and in men and women, respectively. The positive correlation between Ad-SoS and height and the negative one between Ad-SoS and age was found in the entire group of patients with acromegaly. No correlations between Ad-SoS and time from diagnosis or duration of the symptoms were found. Age affected Ad-SoS significantly less in the entire patient group than in controls. Similarly, in women, age and body mass affected Ad-SoS less than in controls. A stepwise multiple regression analysis carried out in the patient group identified age as the only factor significantly influencing negatively the Ad-SoS value (regression equation: Ad-SoS (m/s) = 2124 m/s - 3.26 x age (years) [r2= 0.26, standard error of estimate = 55.1, p < 0.01]). In conclusion, our data demonstrate that, in patients with acromegaly, skeletal status assessed by QUS was affected. This could reflect the worsening of the mechanical properties of bones studied and the increased risk of fractures in other sites of the skeleton. The changes observed were not related to acromegaly-associated hypogonadism. Further studies to assess the role of QUS in acromegaly are necessary and fracture prevalence and risk ought to be established.
Marcello Alves Pinto
Full Text Available CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.
Körbler, C; Pfau, M; Becker, F; Koester, U; Werdin, F
In the modern treatment of CRPS a multidisciplinary concept is firmly established (MMPT, multimodal pain therapy). Besides medical therapy and psychotherapy, physio- and occupational therapy count as basic treatment options. Although physio- and occupational therapy (in the following called hand therapy) are the most important basic treatments, the therapy is hardly standardised and there are few scientific investigations concerning their application. Therefore the purpose of this paper is to present the applied hand therapeutic techniques with regard to function/performance, application and effectiveness, and to derive a suitable treatment algorithm. The techniques used in hand therapy are presented and reviewed in regard to their effectiveness by means of a literature search. It turns out that exercise therapy, manual therapy, graded motor imaging, CO2 baths and occupational therapy have a proven benefit for the patients. Although for many of the treatments reliable evidence-based data are lacking a treatment algorithm was established but there is a strong need for further investigations concerning the therapeutic effectiveness in the treatment of CRPS. © Georg Thieme Verlag KG Stuttgart · New York.
Dunpath, Tanuja; Chetty, Verusia; Van Der Reyden, Dain
This study endeavoured to explore the experiences of adult patients with acute burns of the hand in order to gain insight and understanding the effects of the burn injury on their participation in rehabilitation. A qualitative study design that adopted an explorative and interpretive phenomenological approach was employed, using the International Classification of Function, Disability and Health (ICF) as a conceptual framework. Five participants with acute hand burn injuries were recruited from five public hospitals in KwaZulu-Natal to participate in an in-depth semi structured interview. The results revealed that some of the most significant components of the burn experience included the trauma of the incident, fear of the pain during therapy, stigmatisation as well as, more positively, personal growth as a result of overcoming physical limitations and achieving independence in their activities of daily living. This study showed that a holistic approach, in which the physical, psychosocial and emotional needs of the individual were addressed, was paramount to the patients' experience of therapy, recovery and future outlook. It emphasised the need for early psychological intervention and the value of providing an understanding and empathetic approach in addressing the needs and expectations of the patient.
Nielsen, N H; Kristiansen, J; Borg, L
The present study aimed at evaluating the effects of daily repeated exposures to low cobalt or chromate concentrations on the hands of patients with hand eczema and cobalt or chromate allergy. For 2 weeks, the patients immersed a finger for 10 min daily into the appropriate metal salt solution...... of providing evidence-based medicine in the area of allergic contact dermatitis in the future....
Joshua M. Abzug
Full Text Available Background: Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH. It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations. Methods: All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher’s exact test was conducted to compare current trends with previous trends. Results: Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations were in Journal of Hand Surgery , and 11% (59 entations were in Journal of Bone and Joint Surgery . Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004. Conclusions: Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-eviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery .
Grode, Jesper Nicolai Riis; Grode, Louise; Steinsøe, Ulla
to the type of anaesthetics, surgery, fasting regimes, etc., for each patient scenario. The material must have a professional look and should be provided in a language native to the patient. Finally it is a requirement to document what information material has been handed out. A 3-tier software architecture...... was established to support these requirements. A relational database system holds all information pieces in a granular, structured form. Each individual piece of information can be joined with other pieces thus supporting the tailoring of information. A web service layer caters for integration with output systems...
Cramer, John D; Dilger, Amanda E; Schneider, Alex; Smith, Stephanie Shintani; Samant, Sandeep; Patel, Urjeet A
Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). This cohort study compared the rate of VTE after different otolaryngology procedures with those of general and plastic surgery in the American College of Surgeons National Surgical Quality Improvement Program from January 1, 2005, through December 31, 2013. We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. Surgery. Thirty-day rate of VTE. A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white) were compared. The overall 30-day rate of VTE was 0.5% for otolaryngology compared with 0.7% for plastic surgery and 1.2% for general surgery. We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced
... page: https://medlineplus.gov/news/fullstory_167721.html Obesity Slows Recovery for Heart Surgery Patients: Study They' ... Aug. 10 in The Annals of Thoracic Surgery . "Obesity is a growing problem for society that has ...
Sousa, Cristina Silva; Turrini, Ruth Natalia Teresa
To create and validate educational material for patients undergoing orthognathic surgery. The design included five phases: (a) a review of the literature regarding surgical complications; (b) gathering information on the needs of patients through blogs and virtual communities; (c) evaluating patient perceptions of the post-operative period through a focus group; (d) obtaining information through specialists using the Delphi technique and validation by judges; and (e) validation by patients in terms of understanding the exhibited material. The first three phases of the study and the first round of the Delphi technique assisted in generating the perioperative patient booklet. The following rounds of the Delphi technique introduced modifications to improve the material, with the judges agreeing on the final material to be validated by patients. Creating a booklet involves more than simply writing summarized ideas on a paper and handing it to the patient. One must understand the population, involve the relevant professionals, and obtain high-quality graphic aids for this type of educational material. Copyright © 2012. Published by Elsevier B.V.
Fox, Cherie; Wavra, Teresa; Drake, Diane Ash; Mulligan, Debbie; Bennett, Yvonne Pacheco; Nelson, Carla; Kirkwood, Peggy; Jones, Louise; Bader, Mary Kay
Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections. ©2015 American Association of Critical-Care Nurses.
Crockett, Richard J; Pruzinsky, Thomas; Persing, John A
The aim of this study was to survey first-time patients seeking cosmetic surgery and examine what role "reality TV" played in their perception of the risks and benefits of surgery and their overall decision-making process. Information on demographics, television viewing patterns, and patients' self-assessed plastic surgery knowledge was collected from 42 patients. They were asked how similar they believed the shows were to real life and what degree of influence the shows had on their decision to pursue cosmetic surgery. Patients were then divided into groups by program viewing intensity. Fifty-seven percent of patients were "high-intensity" viewers of plastic surgery reality television shows. When compared with low-intensity viewers, high-intensity viewers believed themselves to be more knowledgeable about plastic surgery (p reality television plays a significant role in cosmetic surgery patient perceptions and decision making. Patients who regularly watched one or more reality television show reported a greater influence from television and media to pursue cosmetic surgery, felt more knowledgeable about cosmetic surgery in general, and felt that plastic surgery reality television was more similar to real life than did low-intensity viewers.
Full Text Available Abstract Background The disabilities of the arm, shoulder and hand (DASH questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. Methods The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6–21 months change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DASH as a measure of treatment effectiveness was assessed after surgery for subacromial impingement and carpal tunnel syndrome by calculating the effect size and standardized response mean. Results Among the 109 patients, the mean (SD DASH score preoperatively was 35 (22 and postoperatively 24 (23 and the mean score change was 15 (13. The effect size was 0.7 and the standardized response mean 1.2. The mean change (95% confidence interval in DASH score for the patients reporting the status of the arm as "much better" or "much worse" after surgery was 19 (15–23 and for those reporting it as "somewhat better" or "somewhat worse" was 10 (7–14 (p = 0.01. In measuring effectiveness of arthroscopic acromioplasty the effect size was 0.9 and standardized response mean 0.5; for carpal tunnel surgery the effect size was 0.7 and standardized response mean 1.0. Conclusion The DASH can detect and differentiate small and large changes of disability over time
Okada, Junko; Yamamizu, Yukiko; Fukai, Kiyoko
The present authors examined how patient hand contamination was associated with underlying disease and treatment environment in order to determine effective hand hygiene methods. Samples were collected from inpatients (45 with hematological malignancies, 48 postoperative), outpatients (48 undergoing hemodialysis, 55 on chemotherapy), and 44 individuals living in nursing homes. All participants provided informed consent for study participation. All subjects performed hand hygiene. Before and after hand hygiene, samples of bacteria were collected from the palm of the hand onto agar media. Bacteria were counted and bacterial strains were identified. The authors then collected smear samples from the contralateral palm and measured adenosine triphosphate (ATP) levels. Patient hand contamination was the highest in hemodialysis patients, followed by residents of nursing homes, postoperative patients, patients with cancer receiving chemotherapy, and patients of hematological malignancies. Regardless of the underlying disease and treatment environment, patients were able to reduce the number of bacterial colonies and ATP by proper hand hygiene. Compared with wet wipes, hand washing seemed to remove bacteria more effectively. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 30 subjects, none of whom were patients of hematological malignancies. Of these, 19 tested negative for MRSA after performing proper hand hygiene. Patient hand contamination is affected by underlying disease and care environment, but can be reduced by encouraging proper hand washing. Proper patient hand hygiene can reduce MRSA on patients' hands, and thus may serve as an effective tool for prevention of healthcare-associated infections. © 2016 Japan Academy of Nursing Science.
Chacko, Vinod; Varvarelis, Nicholas; Kemp, David G
Reliable communication of patient information among physicians during shift changes is an important patient safety parameter. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] recognized the pitfalls in hand off communications by including standardized hand-offs as a National Patient Safety Goals. We are presenting an electronic application called eHand-offs to address this problem in our residency program. Residents can use this application to hand-off patient information during admissions, transfers, and discharges. eHand-offs also functions as a surveillance tool for administrators to track patient hand offs, ensuring added patient safety and enhancing resident supervision and training.
Kim, J M; Zimmerman, R M; Jones, C M; Muhit, A Al; Higgins, J P; Means, K R
Our purpose was to determine the quality of current randomised controlled trials (RCTs) in hand surgery using standardised metrics. Based on five-year mean impact factors, we selected the six journals that routinely publish studies of upper extremity surgery. Using a journal-specific search query, 62 RCTs met our inclusion criteria. Then three blinded reviewers used the Jadad and revised Coleman Methodology Score (RCMS) to assess the quality of the manuscripts. Based on the Jadad scale, 28 studies were of high quality and 34 were of low quality. Methodological deficiencies in poorly scoring trials included the absence of rate of enrolment, no power analysis, no description of withdrawal or dropout, and a failure to use validated outcomes assessments with an independent investigator. A large number of RCTs in hand, wrist, and elbow surgery were of suboptimal quality when judged against the RCMS and Jadad scales. Even with a high level of evidence, study design and execution of RCTs should be critically assessed. Methodological deficiencies may introduce bias and lead to statistically underpowered studies. Cite this article: Bone Joint J 2017;99-B:94-9. ©2017 The British Editorial Society of Bone & Joint Surgery.
Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M
Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.
Meshkat, B; Cowman, S; Gethin, G; Higgins, P; Ryan, K; Mulligan, E
Currently, there is a paucity of research which has assessed practices at the point of care for day surgery patient. To outline the patient journey from first referral for surgery and identify structures and processes which facilitate or constrain the provision of day surgery. A retrospective medical charts review of 200 consecutively presenting patients undergoing elective surgery in two Irish teaching hospitals. Data collection was completed from January 2009 to March 2009. This analysis spanned from first referral to the hospital until discharge and follow up. Great variability was noted in practices between the two hospitals. While some of the differences in practice become barriers to increased rates of day surgery, others did not have an impact. This study echoes findings of other similar studies in that management of patients undergoing elective surgery which varies significantly across Irish hospitals.
This research explores commonplace discursive depictions of obesity surgery and individual patients' reactions to these depictions. Data come from a content analysis of weight loss surgery representations in periodical articles (n = 32) and open-ended surveys (n = 55) and interviews (n = 44) with surgery patients from 34 US states. This study reveals that mainstream periodicals frequently stigmatized patients as obesity surgery is cast as (1) medically risky, (2) extravagant and (3) an overly easy escape from obesity. Surgery is only portrayed as (4) acceptable when multiple other weight loss techniques had been tried unsuccessfully. In contrast, interview and survey data show individual patients are aware of, yet frequently refute, these surgical stigmas. Findings demonstrate the importance of weight loss surgery patients' personal experiences, interactions and education in shaping their responses to stigma. Patients view themselves as expert insiders who negotiate dominant discourses and, consequently, assert that surgery and surgery patients are ethical. Research results reveal the importance of perceived expert insider status and interpretive practice in managing obesity surgery stigma. Copyright © 2011 Elsevier Ltd. All rights reserved.
Beek, E.S.J. van der
The dramatic rise of morbid obesity worldwide and the success of bariatric surgery results in a significant rise in the demand for post-bariatric body contouring surgery, a new field in plastic surgery. This makes a national clinical guideline for patient selection and treatment mandatory. In
Lupión, Carmen; López-Cortés, Luis Eduardo; Rodríguez-Baño, Jesús
Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Gu, Alex; Almeida, Neil; Cohen, Jordan S; Peck, Kathryn M; Merrell, Gregory A
For scientists, authorship is academic currency. Authorship characteristics have been studied in a subset of the surgical and medical literature, but trends in the specialty of hand surgery have not yet been investigated. Specifically, a longitudinal analysis of number, educational training, sex, and geographical origin of authors has not been conducted. We explored the progression of authorship of scientific articles in a leading hand surgery journal. We recorded number of authors, number of references, degrees, and sex of the first and senior authors as well as geographical origin of the corresponding author in The Journal of Hand Surgery in 1985, 1995, 2005, and 2015. All original work was analyzed. A total of 892 articles were reviewed. The mean number of authors per article increased significantly from 2.6 in 1985 to 3.9 in 2015 and the number of references increased significantly from 13.7 in 1985 to 22.6 in 2015. There was a significant increase in the proportion of first authors with an MD/PhD, PhD, master's or bachelor's degree since 1985. During that same time period, a decrease in the proportion of first authors who held solely an MD was seen. There was a significant increase in proportion of the number of last authors with an MD/PhD, PhD or Master's degree in that same time period. There has been significant growth in publications originating from the "Far East" and "Other" regions, with 4.2% and 5.0% of publications, respectively, in 1985 having increased to 10.3% and 7.4% of publications, respectively, in 2015. Female first authorship significantly increased over the study period from 7.9% in 1985 to 22.1% of publications in 2015. There has been a significant increase in number of authors per article in The Journal of Hand Surgery. Similar to other studies, we noted shifts in the degrees most commonly held by authors, an increase in references per article, and a greater representation of international authors in the hand surgery. In addition, the
Koster, E.S.; Schmidt, Alain; Philbert, D.; van de Garde, E.M.W.; Bouvy, M.L.
Aim Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery.
Ediz, Levent; Ceylan, Mehmet Fethi; Hız, Özcan; Tekeoğlu, İbrahim
Abstract. We described the first case report in the literature who developed Complex Regional Pain Syndrome (CRPS type I) symptoms in his right shoulder and right hand within 15 days after open cardiac surgery and discussed shoulder-hand syndrome (CRPS type I) and frozen shoulder diagnosis along with the reasons of no report of CRPS type I in these patients. We also speculated whether frozen shoulder seen in postthoracotomy and postcardiac surgery patients might be CRPS type I in fact.Key w...
Stenekes, Martin W.; Nicolai, Jean-Philippe A.; Geertzen, Jan H. B.; Mulder, Theo
Objective: Although several hand outcome tests exist to judge skill level after hand injury, currently none give insight into how tasks are performed by looking at kinematic parameters. In this article, the clinical value of analyzing kinematic parameters related to the drawing of a triangle on a
Bishop, Andrew J.; Zagars, Gunar K. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Moon, Bryan S.; Lin, Patrick P.; Lewis, Valerae O. [Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: firstname.lastname@example.org [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas (United States)
Purpose: The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with limb-sparing surgery and radiation therapy (RT) for soft tissue sarcomas (STS) of the hands and feet. Methods and Materials: We reviewed the medical records of 85 consecutive patients treated for STS of the hands (n=38, 45%) and feet (n=47, 55%) between 1966 and 2012. The median age was 41 years (range, 10-82 years of age). Sixty-seven patients (79%) received postoperative RT after resection of their tumor (median dose, 60 Gy; range, 45-70 Gy). The remaining 18 patients (21%) were treated with preoperative RT followed by tumor resection (median dose, 50 Gy; range, 50-64 Gy). Results: Median follow-up was 140 months (range, 24-442 months). Five-year local control, overall survival, and disease-specific survival rates were 86%, 89%, and 89%, respectively. Positive or uncertain surgical margin status was the only factor adversely associated with local recurrence (19% vs 6% for negative margins, P=.046) but this lost significance on multivariate analysis when adjusting for RT dose ≥64 Gy. Of the 12 patients who had local relapses, 6 (50%) were salvaged, and only 2 of those required salvage amputation. Five patients had grade ≥3 late RT sequelae, with 2 patients (2%) having moderate limitations of limb function and 3 patients (4%) having severe limitations requiring procedures for skin ulceration. Conclusions: Limb-sparing surgery combined with RT provides excellent local control outcomes for sarcomas arising in the hands or feet. In patients who have local recurrence, salvage without amputation is possible. The excellent cancer control outcomes observed, considering the minimal impact on limb function, support use of combined modality, limb-sparing local therapy for STS arising in the hands or feet.
Full Text Available Moa Jeong,1 Hyung Koo Kang,1 Pamela Song,2 Hye Kyeong Park,1 Hoon Jung,1 Sung-Soon Lee,1 Hyeon-Kyoung Koo1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, 2Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea Purpose: Hand grip strength (HGS is a simple way of predicting the risk of cardiovascular disease and all-cause mortality in the general population. However, the practical significance of grip strength in patients with COPD is uncertain. The aim of this study was to compare HGS between subjects with and without COPD and to evaluate its clinical relevance in patients with COPD by using a national survey.Methods: Data were collected from the Korean National Health and Nutrition Examination Survey. The study included 421 adults with COPD and 2,542 controls who completed questionnaires, spirometry, and a HGS test. HGS was compared between subjects with and without COPD, and the association between grip strength, lung function, and quality of life (QoL was evaluated.Results: The mean HGS was 33.3±9.1 kg in the COPD group and 29.9±9.5 kg in the non-COPD group; adjusted HGS was 30.9±0.33 kg and 30.9±0.11 kg, respectively (P=0.99. HGS was not related to forced vital capacity (β=0.04, P=0.70 or forced expiratory volume in 1 second (β=0.11, P=0.24 in multivariable analysis. HGS was independently associated with the EQ-5D index, but the relationship was stronger in the COPD group (β=0.30, P<0.001 than in the non-COPD group (β=0.21, P<0.001. The results were similar for each component of the EQ-5D, including mobility (β=-0.25, P<0.001, daily activity (β=-0.19, P=0.01, pain/discomfort (β=-0.32, P<0.001, and anxiety/depression (β=-0.16, P=0.01.Conclusion: HGS was not different between subjects with and without COPD, but was associated with QoL – including mobility, daily activity, pain/discomfort, and anxiety/depression – in patients with COPD. The
Cetin, Ibrahim Ilker; Aktaş, Dilek; Tunçbilek, Ergül
This report describes a patient who had bilateral facial nerve paralysis, external ophthalmoplegia, absence of pectoralis major muscle at right side, ipsilateral hand and foot, and contralateral hand anomalies. To our knowledge, this is the first patient with Poland syndrome reported in combination with Moebius syndrome, presenting with contralateral hand and ipsilateral foot anomalies.
Richter, Johan C O; Haj-Hosseini, Neda; Hallbeck, Martin; Wårdell, Karin
Visualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection. Eighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe. Fluorescence ratio medians (range 0 - 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as "none" (0.3, n=131), "weak" (1.6, n=34) and "strong" (5.4, n=28). Of 131 "none" points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe. The probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Sofela, Agbolahan A; Laban, James T; Selway, Richard P
To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.
Manske, Mary Claire B; Rios Roque, Jairo J; Zelaya, Gabriel Ramos; James, Michelle A
Recent reports have demonstrated that nearly two-thirds of the world's population do not have access to adequate surgical care, a burden that is borne disproportionately by residents of resource-poor countries. Although the reasons for limited access to surgical care are complex and multi-factorial, among the most substantial barriers is the lack of trained surgical providers. This is particularly true in surgical subspecialties that focus on life-improving, rather than life-saving, treatments, such as pediatric hand and upper extremity surgery, which manages such conditions as congenital malformations, trauma and post-traumatic deformities including burns, and neuromuscular conditions (brachial plexus birth palsy, spinal cord injury, and cerebral palsy). Many models of providing surgical care in resource-limited environments have been described and implemented, but few result in sustainable models of health-care delivery. We present our experience developing a pediatric hand and upper extremity surgery training program in Nicaragua, a resource-limited nation, that grew out of a collaboration of American and Nicaraguan orthopedic surgeons. We compare this experience to that of surgeons undergoing subspecialty training in pediatric upper limb surgery in the US, highlighting the similarities and differences of these training programs. Finally, we assess the results of this training program and identify areas for further growth and development.
Liodaki, Eirini; Kisch, Tobias; Mauss, Karl L; Senyaman, Oezge; Kraemer, Robert; Mailänder, Peter; Wünsch, Lutz; Stang, Felix
Hand burns are common in the pediatric population. Optimal hand function is a crucial component of a high-quality survival after burn injury. This can only be achieved with a coordinated approach to the injuries. The aim of this study was to review the management algorithm and outcomes of pediatric hand burns at our institution. In total, 70 children fulfilling our study criteria were treated for a burn hand injury in our Burn Care Center between January 2008 and May 2013. 14 of the 70 pediatric patients underwent surgery because of the depth of the hand burns. The management algorithm depending on the depth of the burn is described. Two patients underwent correction surgery due to burn contractures later. For a successful outcome of the burned hand, the interdisciplinary involvement and cooperation of the plastic and pediatric surgeon, hand therapist, burn team, patient and their parents are crucial.
Elaqoul, Aqel; Obaid, Abdullah; Yaqup, Eman; Shahen, Ibtesam; Arraqap, Ahmad; Alshatnawi, Iyad; Alnajar, Malek; Al-Momani, Sharaf
Postoperative pain occurs at a high incidence after day-case surgery, with many patients reporting moderate to severe pain. A cross-sectional design was used in this study to estimate the prevalence of postoperative pain in the early postoperative period after day-case surgery and to determine whether there is a relationship between demographic and clinical variables. A convenient sample of 300 patients, aged between 18 and 80 years, was selected from all postoperative patients after day-case surgery over a period of 6 months. At the first 2 hr after surgery, about 70% of patients had either no pain or mild pain at rest and about 30% of patients had moderate to severe pain. About one third of these patients (103; 35.8%) reported mild pain, and about 43% of patients had moderate to severe pain on movement in the first 2 hr after surgery. Furthermore, 25.3% and 41.3% of the patients reported moderate to severe pain during the first 24 hr after hospital discharge at rest and on movement, respectively. Female patients had significantly higher pain scores than male patients (p postoperative patients after day-care surgery in Jordan is high. Young adult and female patients have higher pain scores after day-case surgery.
Nayara de Castro Pereira; Ruth Natalia Teresa Turrini; Vanessa de Brito Poveda
Abstract OBJECTIVE To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. METHOD Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. RESULTS The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of h...
Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir
Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...
Durand, Wesley M; Johnson, Joseph R; Eltorai, Adam E M; Daniels, Alan H
Crowdfunding for medical expenses is growing in popularity. Through several websites, patients create public campaign profiles to which donors can contribute. Research on medical crowdfunding is limited, and there have been no studies of crowdfunding in orthopedics. Active medical crowdfunding campaigns for orthopedic trauma, total joint arthroplasty, and spine surgery were queried from a crowdfunding website. The characteristics and outcomes of crowdfunding campaigns were abstracted and analyzed. For this study, 444 campaigns were analyzed, raising a total of $1,443,528. Among the campaigns that received a donation, mean amount raised was $4414 (SE, $611). Multivariate analysis showed that campaigns with unspecified location (odds ratio, 0.26; P=.0008 vs West) and those for total joint arthroplasty (odds ratio, 0.35; P=.0003 vs trauma) had significantly lower odds of receipt of any donation. Description length was associated with higher odds of donation receipt (odds ratio, 1.13 per +100 characters; P<.0001). Among campaigns that received any donation, those with Southern location (-65.5%, P<.0001), international location (-68.5%, P=.0028), and unspecified location (-63.5%, P=.0039) raised lower amounts compared with campaigns in the West. Goal amount was associated with higher amount raised (+3.2% per +$1000, P<.0001). Resources obtained through crowdfunding may be disproportionately available to patients with specific diagnoses, those from specific regions, those who are able to craft a lengthy descriptive narrative, and those with access to robust digital social networks. Clinicians are likely to see a greater proportion of patients turning to crowdfunding as it grows in popularity. Patients may ask physicians for information about crowdfunding or request testimonials to support campaigns. Surgeons should consider their response to such requests individually. These findings shed light on the dynamics of medical crowdfunding and support robust personal and
Srigley, J A; Furness, C D; Gardam, M
Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Abstract. Background: Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are ...
Background: Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally ...
Full Text Available Body dysmorphic disorder (BDD refers to a preoccupation with an imagined or grossly exaggerated minor physical defect. Those with BDD might seek medical help (cosmetic surgery rather than attend a psychiatric clinic. Therefore, it is often underdiagnosed. To investigate the prevalence of BDD, we reviewed the medical records of 817 individuals who sought cosmetic surgery during a 3-year period. The outcome after surgery was described for those with BDD. Our results showed that 63 (7.7% patients had BDD, of which 54 (85.7% were diagnosed at preoperative evaluation. However, nine (14.3% patients went undiagnosed and all had a bad outcome after cosmetic surgery. BDD was not uncommon at the cosmetic surgery clinic. Our results support the idea that cosmetic surgery should be avoided for patients with BDD. The development of a more effective diagnostic procedure could help address this issue.
Khan, Ambreen; Nausheen, Sidrah
To evaluate and increase the compliance of surgical hand scrubbing with periodic feedback. This study was conducted at the Aga Khan Hospital for Women and Children, Karachi, Pakistan, from April to July 2014. A remote video auditing system consisting of human auditors was used for visualising surgical hand wash compliance of the surgical team. The equipment, which used motion sensor, was installed in the scrub area wall, visualising the scrub sink only. A clock was displayed for the healthcare professionals to aid in ensuring two-minute hand washing. All surgeons, technicians and surgical assistants were included in the study. Surgical scrubbing was measured during a 4-week period by remote video auditing without feedback and a 12-week period with feedback. SPSS 19 was used for data analysis. Of the 534 observations, 150(28%) were made during the pre-feedback period and 384(71.9%) during the post-feedback period. During the first 4 weeks, the overall compliance was 22(14.6%). The rate of compliance increased to 310(80.7%) during the 12-week post-feedback period. Video surveillance with feedback for hand washing was found to be an effective tool for measuring hand hygiene and improving compliance.
Schroeder, Joshua E; Hughes, Alexander; Sama, Andrew; Weinstein, Joseph; Kaplan, Leon; Cammisa, Frank P; Girardi, Federico P
Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have been reported. All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients' charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed. Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was Parkinson disease severity stage of ≥3 (p Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
Gallagher, Robyn; McKinley, Sharon
Patients undergoing coronary artery bypass surgery who have increased anxiety levels have poorer outcomes than patients with lower levels, yet few studies have identified the concerns associated with this anxiety...
Sessa, Carmine; Riehl, Gregory; Porcu, Paolo; Pichot, Olivier; Palacin, Pedro; Maghlaoua, Mohamed; Magne, Jean-Luc
Hand ischemia is a rare complication of angioaccess surgery for hemodialysis. Management usually requires ligation of the arteriovenous fistula (AVF). The purpose of this report is to describe our experience with the use of the distal revascularization interval-ligation (DRIL) technique for treatment of ischemia without ligation of the AVF. From January 1999 to September 2002, the DRIL technique was used to treat 18 patients (10 men, 8 women, 10 diabetic patients) with severe paresthesia of the hand (n = 9) and finger necrosis (n = 10). The AVF was located at the elbow in 16 patients and at the wrist in 2 patients. Mean flow distal to the AVF was less than 10 mL in 5 patients, less than 5 mL in 10, and unmeasurable in 3. The conduit used for all DRIL arterial bypasses, including 15 brachiobrachial bypasses, 1 axillobrachial bypass, 1 brachioradial bypass, and 1 radioradial bypass, was the great saphenous vein graft. Trophic manifestations required finger amputation in five patients, pulpar necrosis resection in four, and transmetacarpal amputation of the index finger in one patient. Symptoms disappeared in 13 patients (73%) and improved in 5 (27%). The time required for healing of finger amputations and trophic manifestations ranged from 15 days to 2 months. Mean arterial flow through the DRIL bypass was 50 mL/min (range, 20-90 mL/min). With a mean follow-up interval of 16 months (range, 5-48 months), primary patency of the DRIL artery bypass and AVF was 94% and the limb salvage rate was 100%. The DRIL technique is the most effective procedure for treatment of angioaccess-induced hand ischemia. This technique can be used to achieve persistent relief of symptoms with continued access patency. The DRIL artery bypass improves vacularization of the hand, and ligature of the artery stops the vascular steal without affecting hemodialysis access. The DRIL technique should be proposed as first-line treatment for hand ischemia due to AVF for hemodialysis.
Landers, Timothy; Abusalem, Said; Coty, Mary-Beth; Bingham, James
Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Zhang, Yinglei; Zhu, Xiangjia; He, Wenwen; Jiang, Yongxiang; Lu, Yi
Abstract To evaluate the visual outcomes of cataract surgery in patients with uveitis, and to determine risk factors for the recurrence of uveitis and postoperative complications. Eighty patients with uveitis who underwent phacoemulsification with intraocular lens (IOL) implantation were included in this retrospective study. We analyzed the following data: patient characteristics, medications used, visual acuity, and complications of cataract surgery. The mean ± standard deviation time from cataract surgery to the last visit was 20.8 ± 10.4 months. Best-corrected visual acuity improved significantly after surgery (P uveitis. Gender (P = .018) and IOL type (P = .020) were significantly associated with recurrent uveitis after surgery. The incidence of recurrent inflammation was not significantly different between patients who did or did not receive systemic therapy (P = .43). Perioperative systemic therapies (P = .011) and recurrent uveitis within 3 months of surgery (P = .043) were associated with posterior capsular opacification. Perioperative systemic therapies (P = .026) and recurrent uveitis after surgery (P = .006) were also significantly associated with cystoid macular edema. Patients with uveitis could benefit from cataract surgery. Patients with Behçet disease had worse postoperative prognosis than patients with other etiologies of uveitis. A heparin-surface-modified IOL may reduce the incidence of recurrent inflammation. PMID:28746181
The effect of two different orthoses on pain, hand function, patient satisfaction and preference in patients with thumb carpometacarpal osteoarthritis: a multicentre, crossover, randomised controlled trial.
Vegt, A E van der; Grond, R; Grüschke, J S; Boomsma, M F; Emmelot, C H; Dijkstra, P U; Sluis, C K van der
The aim of this study was to compare the Push Ortho Thumb Brace CMC and a custom-made orthosis in the treatment of patients with primary osteoarthritis of the carpometacarpal joint of the thumb. Our outcome measures were pain scores, tests of hand function, patient satisfaction and patient preference. A multicentre crossover randomised controlled trial was conducted which included 63 patients (44 women) with primary osteoarthritis of the carpometacarpal joint of the thumb. Of these, 59 patients with a mean age of 60.1 years (standard deviation 8.2), completed the study. Patients used both orthoses for two weeks with a two-week washout period in-between. Pain was measured on a 10-cm visual analogue scale. Hand function was assessed using the Jebsen Taylor Hand Function test, Nine Hole Peg Test, key grip, pinch grip and Functional Index for Hand Osteoarthritis. Patient preference was assessed using the Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology score. Both orthoses resulted in a minor reduction in pain scores without significant difference between the two orthoses. The Push Ortho Thumb Brace CMC interfered less with key grip (p Thumb Brace CMC had a higher patient satisfaction (p thumb, patients may prefer the Push Ortho Thumb Brace CMC. Cite this article: Bone Joint J 2017;99-B:237-44. ©2017 The British Editorial Society of Bone & Joint Surgery.
Szybiak, Bartosz; Golusiński, Wojciech
Cancer patients after neck surgeries require specific operative and postoperative management, which to some extent determines the final outcome of the surgery. Such procedures require particular attention due to the respiratory and gastrointestinal tracts as well as the presence of functionally and morphologically important anatomical structures on the neck. The majority of patients qualified for surgery have concomitant medical conditions, which increases the probability of certain operative and postoperative complications. Preparation for the procedure requires close cooperation between the laryngologist-head and neck surgeon, general practitioner and anaesthetist. The purpose of the paper was to analyse the factors that influence the normal process of healing in the operative and postoperative periods in patients after neck surgery. The study group consisted of 220 patients who underwent neck surgery in the years 2007-2010. 92.8% of the operations were performed due to a malignant cancer. The following factors were taken into consideration in the evaluation of the healing process: On average, following surgery, patients stayed in the ward for: 5-7 days after selective removal of lymph nodes, 5 days after removal of branchial cleft cyst or persistent thyroglossal duct, 14 days after total laryngectomy, and 12 days after reconstructive laryngeal surgery. All patients after oncological surgery of the oral cavity, oropharynx and larynx stayed in the ICU for the first 24 hours and remained under analgosedation. Laryngeal surgery was performed using a separate surgical incision for tracheotomy. In all cases suction drainage was used for 48 hours. After surgery, patients were mobilised during the first 24 hours in the ward. Appropriate operative and postoperative management, following specific standards, increases the safety of the patient. Providing optimal conditions for healing shortens the patient's stay in the ICU, which reduces the cost of hospitalisation and
Telfeian, Albert E; Iprenburg, Menno; Wagner, Ralf
Transforaminal lumbar endoscopic discectomy is a minimally invasive spine surgery procedure performed principally for the treatment of lumbar herniated discs. Endoscopic spine surgeons around the world have noted how far patients will travel to undergo this minimally invasive spine surgery, but the actual distance patients travel has never been investigated. We present here our analysis of how far patients will travel for endoscopic spine surgery by studying the referral patterns of patients to 3 centers in 3 different countries. Retrospective chart review of de-identified patient data was performed to analyze the distance patients travel for spine surgery. Patient demographic data was analyzed for patients undergoing transforaminal lumbar endoscopic discectomy procedures over the same 8 month period in 2015 at centers in the United States (U.S.), Netherlands, and Germany. Travel distances for patients were determined for 327 patients. The average distance traveled for the U.S. center was 91 miles, the Dutch center was 287 miles, and the German center was 103 miles. For the U.S. center 16% of patients traveled out of state for surgery and for the European centers combined, 4% of patients traveled out of the country for surgery. The period of data analyzed was less than one year and the data collected was analyzed retrospectively. Quality metrics in health care tend to be focused on how health care is delivered. Another health care metric that focuses more on what patients desire is presented here: how far patients will travel for innovative spine care.Key words: Endoscopic spine surgery, transforaminal, minimally invasive, travel, lumbar disc herniation.
Borregaard, Britt; Ekholm, Ola; Riber, Lars
, cross-sectional study (DenHeart). Patient-reported outcome measures included: Short-Form-12, Hospital Anxiety and Depression Scale, EuroQol-5D-5L, HeartQol and Edmonton Symptom Assessment System. Demographic and clinical information was obtained from national registers. RESULTS: Of 354 patients (65% men......, mean age: 68 years), 79% underwent aortic valve surgery. Patients who had undergone aortic valve surgery had more symptoms of anxiety compared with patients who had undergone mitral valve surgery (34% vs 17%, p=0.003, Hospital Anxiety and Depression Scale anxiety cut-off score of eight). Being female...... Analogue Scale. Age and comorbidity were not associated with patient-reported outcomes. CONCLUSION: Patients who had undergone aortic valve and mitral valve surgery did not significantly differ in patient-reported health at discharge, except for symptoms of anxiety. Being female was the only characteristic...
Martina eDe Zwaan; Ekaterini eGeorgiadou; Christine Elisabeth Stroh; Martin eTeufel; Hinrich eKöhler; Maxi eTengler; Astrid eMüller
Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery...
Leegaard, Marit; Watt-Watson, Judy; McGillion, Michael; Costello, Judy; Elgie-Watson, Jeanne; Partridge, Kim
Inadequate knowledge among health care providers is a key barrier to good pain management, and nurses have a major role to provide education to patients. The purpose of this study was to identify nurses' learning needs to prepare patients for managing pain before and after discharge home from cardiac surgery. The overall aim is to develop a pain education intervention for nurses working with cardiac surgical patients. This was a focus groups study. Participants (N=22) were asked about their perceptions of patients' education needs for pain management after cardiac surgery and approaches to help nurses meet these needs. The Pain Beliefs Scale was used to capture nurses' own misbeliefs about pain that would need clarification in a successful pain education intervention. Nurses identified pain management challenges in the hospital, particularly related to patients' age, patient concerns about the use of opioids, the need to use multiple management strategies, and preparing patients to manage pain at home. Pain Beliefs Scale scores were low related to opioid dosing and adverse effects. Participants identified their most helpful educational approaches being brief in-services, hands-on learning, lunch-and-learn sessions, and designated education days. Participants identified the most common pain knowledge gaps for patients before and after discharge after cardiac surgery. These data will be used to develop an education intervention for nurses to help their cardiac surgery patients with more effective pain management strategies before and after discharge home. Copyright © 2011 Lippincott Williams & Wilkins.
Vidal, Eduardo Arevalo; Rendon, Francisco Abarca; Zambrano, Trino Andrade; García, Yudoco Andrade; Viteri, Mario Ferrin; Campos, Josemberg Marins; Ramos, Manoela Galvão; Ramos, Almino Cardoso
Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. Má-rotação intestinal é rara anomalia congênita em adultos de difícil reconhecimento devido à falta de sintomas. O diagnóstico é feito geralmente incidentalmente durante procedimentos cirúrgicos ou durante autópsia. Verificar a ocorrência e reconhecimento não eventual
Methods: We describe the simple, but effective, perivascular axillary block technique we have used for regional anaesthetic blocks for hand surgery. We also undertook a prospective cohort study of all patients undergoing hand surgery under this regional block technique at Mulago Hospital. We abstracted the drug and ...
Lee, Brian J; Nelson, Christine C; Lewis, Craig D; Perry, Julian D
To determine surgical outcomes after external dacryocystorhinostomy (DCR) surgery in patients with Wegener granulomatosis (WG). The authors retrospectively reviewed the charts of consecutive patients with WG who underwent primary or secondary external DCR surgery between January 2001 and January 2010. Clinical data reviewed included patient demographics, systemic disease involvement and immunosuppression therapy, intraoperative biopsy findings, and postoperative outcomes and complications. Success was defined as resolution of epiphora. Sixteen primary external DCRs were performed on 9 patients with WG, and 2 secondary external DCRs were performed on 2 patients. At the time of surgery, all patients with WG were on systemic immunosuppressive agents including methotrexate, rapamycin, sirolimus, tacrolimus, azathioprine, cyclophosphamide, rituximab, and prednisone, and no patients received increased corticosteroids after surgery. Intraoperative biopsy in patients with WG revealed chronic inflammation (4 patients) and fibrosis (1 patient). Silicone stents were removed at an average of 5.8 months (range, 3-12 months). All surgeries were successful in resolving epiphora with an average follow up of 3.5 years (range, 10 months-6 years) and no complications. Primary and secondary external DCR surgery successfully treats nasolacrimal duct obstruction in patients with WG on systemic immunosuppression.
Boonstra, M B; Christoffers, W A; Coenraads, P J; Schuttelaar, M L A
BACKGROUND: Allergic contact dermatitis is a well-known cause of hand eczema, although the influence of contact allergens on different clinical types of hand eczema remains still unclear. OBJECTIVE: To identify most common positive tested allergens among hand eczema patients and to define the
Dexter, Franklin; Birchansky, Lee; Bernstein, James M; Wachtel, Ruth E
The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery." The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon. The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.
Mollerup, Annette; Harboe, Gitte; Johansen, Jeanne D
BACKGROUND AND OBJECTIVE: This study reports the findings from a user evaluation of a counselling programme for hand eczema patients in which face-to-face encounters were supplemented with user access to a new website. PATIENTS AND METHODS: Patients treated for hand eczema in two different settin...
Satoh, Yukitoshi; Matsui, Yoshio; Ogawa, Fumihiro; Amano, Hideki; Hara, Hidenori; Nezu, Kenji; Iyoda, Akira
Computer-controlled stapling systems can improve lung tissue approximation during thoracic surgery. We report our experience with a handy system with computer-controlled placement of staples for lung resection in Japan. The iDrive system is the improved second version of the SurgAssist stapling system. It comprises a self-contained computer microprocessor and hand-held control unit combined with a digital loading unit (a power linear cutter with a blue or green cartridge) for use in open and minimally invasive thoracic surgery. The mounted control unit has two uses: (1) controlling accurate placement of the cartridge by orientating the tip of the rigid and curved shaft and (2) controlling the closure of the stapler and the firing. Each cartridge contains a programmed electronic device that triggers activation of the appropriate program in the self-contained microprocessor. The compression level on lung tissue is determined by the computer. From March to October 2008, the iDrive system was used 53 times in a consecutive series of 39 patients during open thoracic lung surgery. There were 12 women and 27 men. The following procedures were performed: lobectomy, segmentectomy, and wedge resection. The power linear cutters were used for stapling lung parenchyma for wedge resection in 6 patients, bullectomy in 1, segmentectomy in 2, and fissure division in 33. There were no stapling failures and no complications related to the staplers. The new computer-controlled stapling system may be safe and efficient for lung parenchymal tissue resection during open thoracic surgery.
Carlene Johnson Stoklossa
Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.
Kral, J G
Obesity is a disease with many comorbidities, some of which increase perioperative risk and most of which are improved or even cured by weight loss effectively achieved by surgery. Since anti-obesity surgery is "behavioral surgery", outcome is independent of the technical performance of the operation and patient selection is critical. Pre- and postoperative patient education is more important than in other gastrointestinal surgery. For example, knowledge of the "Rules of eating" and the "Rules of vomiting" are essential for outcome of gastric restrictive surgery. Indications for bariatric surgery are evolving as safety is increasing and more long-term data unequivocally demonstrate its effectiveness, leading to adjustments downward in body mass index and minimum age. However, outcome predictors are lacking, though it is recognized that patient knowledge, psychosocial adaptation and motivational factors including secondary gain and other benefits to remaining obese are important. Discrepancies between patients' weight goals, "ideal" or healthy weight for post-obese individuals and realistic weight loss based on body composition and energy balance, contribute to subjective assessment of quality of life after bariatric surgery. Well-designed observational studies rather than randomized trials, which are both ethically and scientifically flawed, are needed to improve patient selection. Until valid outcome predictors have been identified, a staged approach to bariatric surgery entailing long-term reoperation rates of up to 30% will prevail.
Wilkinson Antony N
Full Text Available Abstract Background Patient expectations can be difficult to conceptualise and are liable to change with time, health and environmental factors. Patient expectation is known to influence satisfaction, however little is known about the expectations of patients attending for podiatric surgery. This paper will explore the expectations of a large cohort of patients undergoing elective foot surgery. Methods The UK based podiatric audit of surgery and clinical outcome measurement (PASCOM audit system was applied to a consecutive cohort of patients undergoing elective podiatric surgery in Doncaster, South Yorkshire between 2004 and 2010. Data was collected relating to the surgical episode and patient expectations. A patient questionnaire was administered at 6 months post intervention. Results A total of 2910 unique surgical admissions were completed and satisfaction questionnaires were returned by 1869 patients. A total of 1430 patients answered question 1 which relates to patient expectations. Pain relief was the most frequent expectation with 1191 counts (52.3%, while footwear and mobility accounted for 16.6% and 16.4% respectively. Cosmesis counts occurred less commonly; 12.2%. 709 patients (49.6% stated only a single expectation, 599 patients (41.9% stated two expectations, 114 patients (8% stated three expectations and 7 patients (0.5% stated 4 expectations. Pain relief was the dominant expectation accounting for 515 counts (72.6% of patients who provided only one response. Conclusions This paper demonstrates the expectations of a large cohort of podiatric surgery patients. For the most part patients expect pain relief, improved mobility and improved shoe fitting, while a small number of patients also expect a cosmetic improvement. Further research is required to determine the relationship between patient expectation and health related quality of life, and to determine whether podiatric surgery is successful in addressing the expectations of
Nevola Teixeira, Luiz Felipe; Sandrin, Fabio
Breast cancer is the disease which causes the greatest concern among women worldwide, with an estimated 1,152,161 new cases each year. The improvement of surgical techniques, neoadjuvant and adjuvant treatment enhance the survival time and recovery of these patients. As surgery is the first choice for the treatment of breast neoplasms reconstructive surgery has become an important procedure helping to reconstruct the mutilation after radical or conservative breast surgery. The objective of this article is to review the scientific literature and examine the available data regarding the role of physiotherapy in patients who undergo plastic reconstruction after oncological breast surgery, including suggestions on how physiotherapy could be applied in that population. Our review was obtained by searching the PubMed (National Library of Medicine, USA) and LILACS (Latin American and Caribbean Health Sciences) databases. Terms applied concerned physiotherapy and breast reconstructive surgery. The time of limit for our search was from 1995 until the present date. Fourteen articles were included in our review that matched our search criteria. Physiotherapy is a field that still needs evidence based on daily routine and studies in the oncological physiotherapy field. Evaluation should be standardized and rehabilitation techniques used are empirical and should be researched in patients who undergo plastic reconstruction after breast surgery. The lack of post-surgery exercise protocols makes it difficult to analyse the patient's evolution and makes it a challenge to investigate the true role of physiotherapy in this population.
Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye
Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...
Sachse, Florian; Stoll, Wolfgang
Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, s...
Bebbington, Emily; Furniss, Dominic
We integrated two factors, demographic population shifts and changes in prevalence of disease, to predict future trends in demand for hand surgery in England, to facilitate workforce planning. We analysed Hospital Episode Statistics data for Dupuytren's disease, carpal tunnel syndrome, cubital tunnel syndrome, and trigger finger from 1998 to 2011. Using linear regression, we estimated trends in both diagnosis and surgery until 2030. We integrated this regression with age specific population data from the Office for National Statistics in order to estimate how this will contribute to a change in workload over time. There has been a significant increase in both absolute numbers of diagnoses and surgery for all four conditions. Combined with future population data, we calculate that the total operative burden for these four conditions will increase from 87,582 in 2011 to 170,166 (95% confidence interval 144,517-195,353) in 2030. The prevalence of these diseases in the ageing population, and increasing prevalence of predisposing factors such as obesity and diabetes, may account for the predicted increase in workload. The most cost effective treatments must be sought, which requires high quality clinical trials. Our methodology can be applied to other sub-specialties to help anticipate the need for future service provision. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Figueiredo, Ana Elizabeth; de Siqueira, Soraia Lemos; Poli-de-Figueiredo, Carlos Eduardo; d'Avila, Domingos O
Hand hygiene is essential for preventing peritoneal dialysis (PD)-related infections. The present study compared the effectiveness of two hygiene techniques in reducing the number of colony-forming units (CFUs) on the hands of patients undergoing PD. In this controlled clinical trial, 22 participants enrolled in the same PD program underwent a two-hand evaluation for microbiologic flora. Participants participated in two treatments: a) simple hand hygiene plus antiseptic hand hygiene, in which the patients washed their hands with water and glycerin soap for 1 minute and then rubbed and dried their hands with 70% ethyl alcohol gel; and b) antiseptic hand hygiene, in which the patients rubbed their hands with 70% ethyl alcohol gel until fully dry. To sample distal finger surfaces, we asked the participants to touch sheep blood agar plates directly. The CFU count for both hands was significantly higher in the regular hygiene group than in the gel-only group [69.0 (16.0 - 101.0) CFU vs 9.0 (2.2 - 55.5) CFU, p hand cultures from the regular hygiene group than in those from the gel-only group [69.5 (26.25 - 101.0) CFU vs 9.5 (1.0 - 41.7) CFU; p hands may be more effective than following the regular hygiene recommendations in reducing bacterial populations.
Henn, Curtis M; Patel, Aalok; Wall, Lindley B; Goldfarb, Charles A
To investigate the outcomes following surgical management of unstable and stable ulnar nerves at the elbow in young patients. We retrospectively reviewed the charts of 67 patients who were 30 years old or younger when they underwent primary cubital tunnel surgery at our institution over a 10-year period. In 34 (45%) of these patients, the ulnar nerve either subluxated or perched on the medial epicondyle with elbow flexion and made up the "unstable" cohort. The remaining 42 patients made up the "stable" cohort. Preoperative, intraoperative, and postoperative data were obtained from the patients' charts. Thirty-nine patients completed the following outcome measures: Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), visual analog scale (VAS) for pain and treatment satisfaction, return to sport or full activities, and the presence of persistent symptoms. At an average of 5.6 years following surgery, the unstable cohort had a significantly lower QuickDASH score (6.4 vs 18.6) and a significantly higher VAS for treatment satisfaction (8.7 vs 5.9) compared with the stable cohort. The unstable cohort was also significantly less likely to experience residual symptoms (43% vs 94%), persistent numbness (39% vs 44%), or persistent tingling (22% vs 56%) compared with the stable cohort. Within the stable cohort, patients who underwent simultaneous carpal tunnel release exhibited improved VAS and QuickDASH scores compared with patients who did not. There were no differences in time to return to sports or full activities or pain VAS between the two groups. Surgical management of young patients with symptomatic, unstable ulnar nerves results in superior subjective outcomes compared with surgery in young patients with stable ulnar nerves. Therapeutic III. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi
American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....
Aim: The aim of this study was to determine the number of HIV positive cases undergoing ophthalmic surgery at two centres in Nigeria and to assess if routine testing is clinically or economically effective. Methods: All patients listed for ophthalmic surgery in two eye units in southern Nigeria during a six-month period in 2005,
Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy
AIM: To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. METHODS: We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. RESULTS: Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. CONCLUSION: Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or
Aakerstroem, G.; Makridis, C.; Johansson, H. (Uppsala Univ. Hospital (Sweden). Dept. of Surgery)
In patients with midgut carcinoid tumors a curative, radical tumor removal should be attempted when possible. As these tumors are generally malignant, irrespective of size, the radical surgery implies that intestinal resection for excision of a primary tumor should be combined with an extended mesenteric resection. When the patients present with the carcinoid syndrome the disease is, with few exceptions, too advanced for curative surgery. However, surgery often has to be performed also in patients with the advanced carcinoids. Patients with more extensive disease may thus benefit from surgical debulking of large mesenteric or hepatic metastases. Moreover, when the patients present with abdominal symptoms it is important to exclude a threatening major abdominal complication such as intestinal obstruction or ischemia. As these complications may cause malnutrion and deterioration, it is important to treat them properly, sometimes by repeated surgery. (orig.).
Ridha, H; Colville, R J I; Vesely, M J J
Gynaecomastia reduction surgery is a common male cosmetic procedure. Our clinical experience suggested far lower rates of satisfaction than previously reported. Therefore we evaluated our patient group using a detailed questionnaire designed specifically to assess patient satisfaction with breast attributes and quality-of-life outcome following surgery. The questionnaire was sent to all patients who had surgery for gynaecomastia between January 2000 to January 2006. A total of 74 of the 120 patients contacted returned the questionnaire (62% overall response rate). The patients were divided into 3 groups according to their surgical treatment; liposuction only, excision only and combined excision plus liposuction. The majority of patients underwent surgery for reasons of self-confidence and emotional distress. In all groups surgery resulted in an increase in the mean Likert score (LS). The overall mean LS, combined from all the questions increased from 1.9 ('dissatisfied') to 3.2 ('neither satisfied nor dissatisfied'). Only 62.5% of all patients treated for gynaecomastia were 'satisfied' to 'very satisfied'. This more detailed study has shown that satisfaction rates are not as high as previously published. Patients must be appropriately counselled preoperatively to ensure they have realistic expectations of what can be achieved with surgery. (c) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Peperkorn, Henrik M; Diemer, Julia E; Alpers, Georg W; Mühlberger, Andreas
Embodiment (i.e., the involvement of a bodily representation) is thought to be relevant in emotional experiences. Virtual reality (VR) is a capable means of activating phobic fear in patients. The representation of the patient's body (e.g., the right hand) in VR enhances immersion and increases presence, but its effect on phobic fear is still unknown. We analyzed the influence of the presentation of the participant's hand in VR on presence and fear responses in 32 women with spider phobia and 32 matched controls. Participants sat in front of a table with an acrylic glass container within reaching distance. During the experiment this setup was concealed by a head-mounted display (HMD). The VR scenario presented via HMD showed the same setup, i.e., a table with an acrylic glass container. Participants were randomly assigned to one of two experimental groups. In one group, fear responses were triggered by fear-relevant visual input in VR (virtual spider in the virtual acrylic glass container), while information about a real but unseen neutral control animal (living snake in the acrylic glass container) was given. The second group received fear-relevant information of the real but unseen situation (living spider in the acrylic glass container), but visual input was kept neutral VR (virtual snake in the virtual acrylic glass container). Participants were instructed to touch the acrylic glass container with their right hand in 20 consecutive trials. Visibility of the hand was varied randomly in a within-subjects design. We found for all participants that visibility of the participant's hand increased presence independently of the fear trigger. However, in patients, the influence of the virtual hand on fear depended on the fear trigger. When fear was triggered perceptually, i.e., by a virtual spider, the virtual hand increased fear. When fear was triggered by information about a real spider, the virtual hand had no effect on fear. Our results shed light on the
Kocael, Pinar Cigdem; Simsek, Osman; Saribeyoglu, Kaya; Pekmezci, Salih; Goksoy, Ertugrul
Notwithstanding the significant advantages compared to open surgery, laparoscopic surgery was considered to be contraindicated in pregnant patients. Currently, there are opposing views on the safety of laparoscopic surgery during pregnancy, especially in last trimester. The aim of this study was to examine feasibility of laparoscopic surgery in pregnant women with acute abdomen. We retrospectively reviewed records of all patients who were admitted to the Emergency Department of Cerrahpasa Medical Faculty between January 1995 and January 2013. All clinical data of pregnant patient who underwent laparoscopic surgery were analyzed including inpatient records, operative reports, pathology records, and delivery information. Fourteen pregnant patients (mean gestational age 19.2 weeks, ranged from 9 to 33 weeks) who underwent laparoscopy for appendectomy (n=11), cholecystectomy (n=2), and diagnostic reasons (n=1) were included. Average time of delivery was 37.4 gestational weeks (range 35-40 weeks). Two patients had preterm labor. No complications such as uterine injury, fetal death, or maternal mortality were encountered during laparoscopic procedures Laparoscopic surgery can be safely performed at all trimesters of pregnancy. Laparoscopy may be useful in differentiation of acute abdominal pain in pregnancy and may decrease fetal loss due to delay in diagnosis. shorter operative time reduces negative effects of surgery on mother and fetus.
Katsanevaki, Vikentia J; Tuft, Stephen J
Most procedures to treat refractive error are based on laser surgery, but other techniques are available. We review the relative advantages and the risk associated with the different surgical options. Laser refractive surgery is now a safe and effective alternative to glasses or contact lenses. Because refractive surgery is an area of rapidly developing technology, the relative benefits of the different surgical options remain uncertain. AREAS TO DEVELOP RESEARCH: Controlled trials are needed to provide better guidance as to the relative merits of the different surgical options. Better interventions are required to minimize the biological response after laser surface treatment to eliminate the need for mechanical cutting of a flap for laser in situ keratomileusis. An effective surgical treatment for presbyopia is awaited.
Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H; Taljaard, Monica
Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such
Carr, Tracey; Teucher, Ulrich C; Casson, Alan G
Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.
Hovlid, Einar; von Plessen, Christian; Haug, Kjell
The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and redu...
Garus-Pakowska, Anna; Sobala, Wojciech; Szatko, Franciszek
The Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) state that adequate hand hygiene maintained by medical personnel is an indispensable prerequisite for controlling nosocomial infections. The recommendations of CDC and WHO emphasize the obligation to wash hands after each contact with a patient, after the exposure to a potentially infectious material or upon the contact with objects surrounding the patient. The study was performed by quasi-observation among the group of 188 medical staff members (nurses and physicians) working in three selected hospitals of the Łódź Province. The procedure of hand washing/disinfection performed directly after the patient contact according to the recommendations of CDC and WHO was observed. The results were subject to statistical analysis (p hand washing were recorded. The medical personnel followed the hand hygiene procedures after the patient contact in 26.4% of the situations that require hygiene according to the guidelines. The level of observance of the hand washing procedures depended significantly on the type of performed activity, profession, degree of workload, index of activity, and time of duty hours. The mean time of hand washing after patient contact was 9.2 s for physicians and 6.7 s for nurses. Both the level of observance of hygienic procedures after the contact with patients as well as the time of hand washing are insufficient. There is an urgent need to work out educational programs on maintaining proper hand hygiene for medical personnel.
Full Text Available Objective: Patients receiving haemodialysis treatment generally tend to avoid using the upper extremity with arteriovenous (AV fistulae and it results in impairment of hand functions. Limited data are available about impairment associated with hand complications in those patients The aim of this pilot study is to evaluate the handgrip and pinching strengths and functional level of both hands in patients receiving haemodialysis. Methods: Fifteen chronic renal failure patients receiving haemodialysis (30-83 years and 11 age-matched healthy volunteers participated in the study. All the patients were undergoing treatment through arteriovenous fistulae in the upper extremity. Handgrip strength with a manual dynamometer and pinch strength with a pinchmeter were measured. Functional level of both hands was evaluated with Nine-Hole Peg Test. Results: Handgrip strengths of both hands were lower in patients receiving haemodialysis than healthy control group (p0.05. 9-Hole Peg Test results in both placement and removal showed a great significant difference in both hands with a statistical significance of p<0.001. Conclusion: Our first results revealed that chronic renal failure patients receiving haemodialysis treatment through arteriovenous fistulae in the upper extremity have a significant impairment in strength and functional level of hand. The lack of differences between two hands may be concluded that the upper extremity impairment in patients results from the disease course or haemodialysis treatment, not from the vascular access. J Clin Exp Invest 2015; 6 (2: 110-114
Lee, In-Seon; Jung, Won-Mo; Lee, Ye-Seul; Wallraven, Christian; Chae, Younbyoung
This report describes the brain responses to acupuncture in an upper limb amputee patient. A 62-year-old male had previously undergone a lower left arm amputation following an electrical accident. Using functional MRI, we investigated brain responses to acupuncture stimulation in the aforementioned amputee under three conditions: (a) intact hand, (b) prosthetic hand (used by the patient), and (c) fake fabric hand. The patient described greater de qi sensation when he received acupuncture stimulation in his prosthetic hand compared to a fake hand, with both stimulations performed in a similar manner. We found enhanced brain activation in the insula and sensorimotor cortex in response to acupuncture stimulation in the amputee's prosthetic hand, while there was only minimal activation in the visual cortex in response to acupuncture stimulation in a fake hand. The enhanced brain responses to acupuncture stimulation of the patient's prosthetic hand might be derived from cortical reorganisation, as he has been using his prosthetic hand for over 40 years. Our findings suggest the possible use of acupuncture stimulation in a prosthetic hand as an enhanced sensory feedback mechanism, which may represent a new treatment approach for phantom limb pain. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Epstein, Nancy E.; Gottesman, Malcolm
Background: Few patients with neurodegenerative disorders (ND) (e.g., Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), and Postpolio Syndrome (PPS)) require spinal surgery. Typically, their neurological symptoms and signs reflect their underlying neurologic disorders rather than structural spinal pathology reported on magnetic resonance images (MR) or computed tomographic scans (CT). Methods: The first author, a neurosurgeon, reviewed 437 spinal consultations performed over a 20-month period. Of 254 patients seen in first opinion (e.g., had not been seen by a spinal surgeon), 9 had MS, while 2 had ALS. Of 183 patients seen in second opinion (e.g., prior spinal surgeons recommended surgery), 4 had MS, 2 had ALS, and 1 had PPS. We performed this study to establish how often patients with ND, seen in first or second opinion, require spinal surgery. We focused on whether second opinions from spinal surgeons would limit the number of operations offered to these patients. Results: Two of 11 patients with ND seen in first opinion required surgery. The first patient required a C5-7 laminectomy/C2-T2 fusion, followed by a L2-S1 laminectomy/L5S1 fusion. The second patient required a L2-L3 laminectomy/diskectomy/fusion. However, none of the seven patients seen in second opinion, who were previously told by outside surgeons they needed spinal surgery, required operations. Conclusions: Few patients with neurodegenerative syndromes (MS, ALS, PPS) and reported “significant” spondyloitic spinal disease interpreted on MR/CT studies required surgery. Great caution should be exercised in offering patients with ND spinal surgery, and second opinions should be encouraged to limit “unnecessary” procedures. PMID:24843817
Ong, Arielle Yi Jia; Tan, Joanne; Yeo, Hui Ling; Goh, Mien Li
This project aimed to improve patients' knowledge on the importance of hand hygiene. It involved providing patients with a patient and family education on the importance of hand hygiene using a patient information leaflet that introduces the rationale of hand hygiene, possible consequences of poor hand hygiene, and the seven steps of hand hygiene. This projected used a preimplementation and postimplementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. The implementation occurred in three phases over a period of 6 months from January 2014 to June 2014. The audits took place in two orthopaedic wards in a large acute care setting tertiary hospital in Singapore and involved a sample size of 54 patients. It involved going through the medical records of the cases, assessment of patient knowledge based on the audit criteria, and checking if the patients received the patient information leaflet on hand hygiene. The postimplementation audit found significant improvements in all three audit criteria. The percentage of patients who demonstrated knowledge in the importance of hand hygiene saw an improvement of 48.1%. There was an improvement of 44.5% in nurses' compliance to the documentation of patient education being carried out. The percentage of patients who received a patient information leaflet on hand hygiene saw an increase of 36.1%. This project demonstrated that a preimplementation and postimplementation audit is a viable method to implement change and translate evidence into practice. Through this project, patients gained an understanding on the importance of hand hygiene and could take better ownership of their well being. This may potentially improve hospitalization experience and benefit health outcomes. The positive results of this project are contributed by the enthusiastic involvement of all the stakeholders, from patients and their caregivers to the bedside
Salehahmadi, Zeinab; Rafie, Seyyed Reza
BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr...
Clare, Camille A; Afzal, Omara; Knapp, Kenneth; Viola, Deborah
To determine whether a patient's level of assertiveness and other factors influences her comfort level in asking her provider to wash his or her hands. In this pilot study, we developed a survey to gather cross-sectional information on a variety of factors that might explain patient willingness to ask her health-care provider to wash his or her hands. Three primary predictor variables are analyzed: (1) patient assertiveness; (2) patient familiarity with her healthcare provider; and (3) whether the patient has observed hand-washing behavior. Fifty patients participated from the Obstetrics and Gynecology Department of Metropolitan Hospital Center. Less assertive patients are much less likely than assertive patients to ask physicians to wash hands (25% versus 68%; Fisher's exact test P = 0.0427). Among the 3 assertiveness questions included in the survey, the ability to ask physicians questions during visits is most strongly indicative of willingness to ask about hand washing. Familiarity with the names of regular health-care providers has a statistically significant impact on willingness to ask about hand washing. Evidence suggests that observing hand washing behavior affects willingness to ask, but differences are not statistically significant. Results by socioeconomic status such as age, education, income, and race/ethnicity are inconclusive. A patient's level of assertiveness alone is not sufficient to determine her willingness to inquire about the hand-washing behavior of her provider. A high percentage of patients did not see their provider engaging in adequate hand washing behavior. If patients feel comfortable with their provider to inquire about their care and request hand-washing behavior, health outcomes are affected by reducing the rates of health care-associated infections.
Schweiger, Chaya; Keidar, Andrei
The number of people suffering from surgery and obesity in the western world is constantly growing. In 1997 the World Health Organization (WHO) defined obesity as a plague and one of greatest public health hazards of our time. The National Institution of Health (NIH) declared that surgery is the only long-term solution for obesity. Today there are four different types of bariatric surgery. Each variation has different implications on the nutritional status of bariatric surgery patients. Bariatric surgery candidates are at risk of developing vitamin and mineral nutritional deficiencies in the post-operative stage, due to vomiting, decrease in food intake, food intolerance, diminution of gastric secretions and bypass of absorption area. It is easier and more efficient to treat nutritional deficiencies in the preoperative stage. Therefore, preoperative detection and correction are crucial. Blood tests before surgery to detect and treat nutritional deficiencies are crucial. In the postoperative period, blood tests should be conducted every 3 months in the first year after operation, every six months in the second year and annually thereafter. Multivitamin is recommended to prevent nutritional deficiencies in all bariatric surgery patients. Furthermore, iron, calcium, Vitamin D and B12 are additionally recommended for Roux-en-Y Gastric Bypass patients. Patients with Biliopancreatic diversion and Duodenal Switch should also take fat soluble vitamins.
Vassiliou, Melina C; Dunkin, Brian J; Fried, Gerald M; Mellinger, John D; Trus, Thadeus; Kaneva, Pepa; Lyons, Calvin; Korndorffer, James R; Ujiki, Michael; Velanovich, Vic; Kochman, Michael L; Tsuda, Shawn; Martinez, Jose; Scott, Daniel J; Korus, Gary; Park, Adrian; Marks, Jeffrey M
The Fundamentals of Endoscopic Surgery™ (FES) program consists of online materials and didactic and skills-based tests. All components were designed to measure the skills and knowledge required to perform safe flexible endoscopy. The purpose of this multicenter study was to evaluate the reliability and validity of the hands-on component of the FES examination, and to establish the pass score. Expert endoscopists identified the critical skill set required for flexible endoscopy. They were then modeled in a virtual reality simulator (GI Mentor™ II, Simbionix™ Ltd., Airport City, Israel) to create five tasks and metrics. Scores were designed to measure both speed and precision. Validity evidence was assessed by correlating performance with self-reported endoscopic experience (surgeons and gastroenterologists [GIs]). Internal consistency of each test task was assessed using Cronbach's alpha. Test-retest reliability was determined by having the same participant perform the test a second time and comparing their scores. Passing scores were determined by a contrasting groups methodology and use of receiver operating characteristic curves. A total of 160 participants (17 % GIs) performed the simulator test. Scores on the five tasks showed good internal consistency reliability and all had significant correlations with endoscopic experience. Total FES scores correlated 0.73, with participants' level of endoscopic experience providing evidence of their validity, and their internal consistency reliability (Cronbach's alpha) was 0.82. Test-retest reliability was assessed in 11 participants, and the intraclass correlation was 0.85. The passing score was determined and is estimated to have a sensitivity (true positive rate) of 0.81 and a 1-specificity (false positive rate) of 0.21. The FES hands-on skills test examines the basic procedural components required to perform safe flexible endoscopy. It meets rigorous standards of reliability and validity required for high
Valente, Paola; Buzzonetti, Luca; Dickmann, Anna; Rebecchi, Maria Teresa; Petrocelli, Gianni; Balestrazzi, Emilio
To assess the efficacy and safety of LASIK in patients with high myopic anisometropia and to provide specific screening guidelines for anisometropic patients undergoing refractive surgery. Twenty-six eyes of 16 patients with high myopic anisometropia (>3.0 diopters) were enrolled in this study. Complete pre- and postoperative ophthalmologic and orthoptic examinations were performed. The preoperative orthoptic examination was done with glasses and contact lenses. Twenty-two eyes of 13 patients underwent uncomplicated LASIK; the second eye was treated 2 weeks after the first eye. Patients were examined 1 day, 7 days, and 1, 3, 6, and 12 months after surgery. Thirteen patients obtaining good results at red glass bar test (RGB) underwent LASIK without postoperative diplopia; four showed an improvement of the sensorial assessment. Three patients were excluded from surgery because of diplopia with RGB values eye of one patient; however, the diplopia disappeared after surgery of the fixating eye. Patients with high myopic anisometropia and a weak sensorial state who undergo refractive surgery may be at risk for postoperative diplopia. We suggest clinical guidelines to reduce the occurrence of this complication.
H.R. Langeveld-Benders (Hester)
markdownabstract__Abstract__ The introduction of surgical mesh to create a tension free repair in inguinal hernia surgery in the 1990s, was quickly implemented worldwide, because recurrence rates dropped dramatically. Debate on the best surgical approach for this tension-free mesh repair is
Chapter 2 describes the results of a RCT on the effect of a restrictive trigger on RBC sparing. In three hospitals, a restrictive transfusion policy was compared with standard care transfusion policy. A randomised comparison of transfusion triggers in elective orthopaedic surgery using
Becking, A. G.; Tuinzing, D. B.
The surgical treatment of mentally retarded children for esthetic reasons is discussed. In mentally retarded adults a facial deformity can give rise to functional problems; in some cases a facial deformity can stigmatize the mental state. In selected cases orthognathic surgery may offer a solution
Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut\\/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the “avocado hand”. We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.
De Witte, Elke; Van Hecke, Wim; Dua, Guido; De Surgeloose, Didier; Moens, Maarten; Mariën, Peter
Approximately 97% of the right-handers has left hemisphere language dominance. Within the language dominant hemisphere Broca's area is of crucial importance for a variety of linguistic functions. As a result, tumour resection in and around Broca's area is controversial. However, studies showed that by means of Direct Electrical Stimulation (DES) tumour resection in this region can be safely performed. We report unexpected anatomoclinical findings in a right-handed patient who underwent tumour resection in the left prefrontal lobe. Language functions in this right-handed patient were extensively examined in the pre-, intra-, and postoperative phase by means of a standardised battery of neurolinguistic and neurocognitive tests. Results obtained in the pre- and postoperative phase are compared. In addition, intraoperative DES findings and postoperative functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) results are reported. Tumour resection near Broca's area was safely performed since no positive language sites were found during intraoperative DES. Since no linguistic deficits occurred in the pre-, intra-, or postoperative phase, atypical language dominance was suspected. Neuropsychological investigations, however, disclosed permanent executive dysfunction. Postoperative fMRI and DTI confirmed right cerebral language dominance as well as a crossed cerebro-cerebellar functional link with the left cerebellar hemisphere. Atypical right hemisphere language dominance in this right-handed patient is reflected by: (1) the total absence of language problems in the pre-, intra- and postoperative phase, (2) absence of positive stimulation sites during DES, (3) a clearly more pronounced arcuate fasciculus in the right cerebral hemisphere (DTI), (4) a crossed functional connection between the right cerebrum and the left cerebellum (fMRI). Two hypothetical explanations for the pattern of crossed cerebral language dominance are put forward: (1
Yu, Ji-Feng; Liang, Li; Wen, Yu-Qin; Liu, Li; Huang, Yi-Fei
To investigate patient's visual experience during vitreous surgery under local anesthesia. A prospective and randomized study of 76 patients that underwent vitreous surgeries in our hospital between July 2010 and December 2010 was designed. All patients were interviewed half an hour before and within 1 hour after the surgery using a standardized questionnaire. Basic characteristics of patients and their intraoperative visual experiences like light, color, moving object, pain, fear, and the desire for general anesthesia before and after the surgery were recorded. Sixty patients (78.9%) perceived at least light perception, and 16 patients (21.1%) got no light perception throughout the entire duration of the operation. Forty one patients (53.9%) perceived only light, while 19 patients (25%) experienced moving objects. Thirty nine patients (51.3%) were frightened during their intraoperative visual experiences. Patients with better preoperative best-corrected visual acuity (BCVA) were more likely to be frightened (p=0.002). The frightened experience was affected notably by the different perceptions during operation, moving object (p=0.024), light (p=0.071), and color (p=0.071). Patients below 50 years old, especially from 20 to 30, were more likely to choose general anesthesia after the vitreous surgery. Most patients (78.9%) experienced at least light perception during the vitreous surgery under local anesthesia. There were no significant differences between the various visual experiences and their basic characteristics. Patients with better preoperative BCVA, perceived moving objects in their visual sensations seemed more likely to be frightened.
Full Text Available Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (% with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. Keywords: morbid obesity, bariatric surgery, elderly, gastric bypass, weight loss, laparoscopy
Dunda, Sebastian E.; Bozkurt, Ahmet; Pallua, Norbert; Krapohl, Björn Dirk
Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures. Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma. Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment. Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases. PMID:26734539
Dunda, Sebastian E.
Full Text Available Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures.Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma.Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment.Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases.
Objective: This study was carried out to determine the causes of fear and anxiety in consecutive patients who attended the University of Benin Teaching Hospital for minor oral surgical treatment. Method: All consenting consecutive patients referred for minor oral surgery were studied. Information on all the patients was ...
Nikiphorou, Elena; Carpenter, Lewis; Morris, Stephen; Macgregor, Alex J; Dixey, Josh; Kiely, Patrick; James, David W; Walsh, David A; Norton, Sam; Young, Adam
To assess whether there have been any secular changes in orthopedic interventions in patients with rheumatoid arthritis (RA) since 1986, as examined in 2 early rheumatoid arthritis (RA) inception cohorts with up to 25 years of followup. The study examined orthopedic data from the UK Early RA Study (1986-1999, 9 centers; n = 1,465) and the UK Early RA Network (2002-2012, 23 centers; n = 1,236) with linkage to national data sets (Hospital Episode Statistics, National Joint Registry, and Office of National Statistics). Clinical and laboratory measures and hand and foot radiographs were standardized and obtained yearly in both cohorts. The use of disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and biologic therapies reflected the contemporary conventional practices and guidelines of the time frames examined. Recruitment years were grouped into 6 periods, and interventions were classified into major, intermediate, and minor categories. A total of 1,602 orthopedic surgical procedures were performed in 770 patients (29%) over a maximum of 25 years of followup. The 25-year cumulative incidence rate of major interventions was 21.7% (range 19.4-24.0%), and that of intermediate interventions was 21.5% (range 17.8-25.5%). There was a decline in the 10-year cumulative incidence of intermediate surgeries over time (P foot surgery showed a consistent decline from 1986 to 2011. Possible explanations include differences in the pathophysiologic processes affecting the joints, variations in the responses to therapy between large-joint and small-joint destructive processes, and changes in service provision and thresholds for surgery over time. Copyright © 2014 by the American College of Rheumatology.
Bundgaard-Nielsen, M; Jørgensen, C C; Secher, N H
BACKGROUND: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only......), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a >or=10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume...... limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. METHODS: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20...
Dowling, Nicki A; Honigman, Roberta J; Jackson, Alun C
Plastic surgeons have traditionally perceived male patients as more psychologically disturbed than female patients. This study employed a matched sample design to explore the psychosocial experiences of 50 male and 50 female elective cosmetic surgery and cosmetic dentistry patients. It also aimed to compare male and female patients on preoperative psychosocial dysfunction on standardized measures (psychiatric disturbance, anxiety, depression, low self-esteem, dysmorphic concern, and low body image) and postoperative dissatisfaction. The findings revealed that there were many similarities between the self-reported appearance concerns, motivations for surgery, and expectations of surgery between male and female patients. Although male patients did not report higher levels of preoperative psychosocial dysfunction than their female counterparts, they were more likely to report postoperative dissatisfaction. Preoperative screening is recommended to identify the minority of male patients who will report an unsatisfactory outcome despite a technically good result.
Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher
The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Cantero-Téllez, Raquel; Martín-Valero, Rocío; Cuesta-Vargas, Antonio
To assess the relationship between muscle strength (Jama), and pain (VAS) levels with hand function (DASH) in patients with trapeziometarcapal osteoarthritis. Cross-sectional study. Sample of 72 patients with osteoarthritis stage 2-3 (Eaton) and trapeziometacarpal osteoarthritis. Patients were recruited when they came to the Hand Surgery Unit. Grip strength, pinch, pain and hand function were measured, and correlation and regression coefficients between them were obtained. For function, the most significant model (R(2)=0.83) included pain and strength. But it is tip to tip pinch force which has a stronger relationship with DASH (Standardized B: -57) questionnaire. Pain also influenced strength measured with the dynamometer but it was tip to tip pinch force that was the most affected. Findings confirm that there is a significant correlation between function referred by the patient and variables that can be measured in the clinic such as grip strength and pinch. The correlation between pain intensity and function was also significant, but tip to tip pinch strength had the greatest impact on the function. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.
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 because of Dupuytren's disease were actually adhered to, and, to analyse differences in outcomes between patients who were referred according to the criteria (correctly referred) and those who were not...
Scalone, L; Cortesi, P A; Mantovani, L G; Belisari, A; Ayala, F; Fortina, A B; Bonamonte, D; Borroni, G; Cannavò, S P; Guarneri, F; Cristaudo, A; De Pità, O; Gallo, R; Girolomoni, G; Gola, M; Lisi, P; Pigatto, P D; Satta, R; Giannetti, A
Data on the epidemiological impact and clinical characteristics of chronic hand eczema in Southern Europe are lacking. To estimate the prevalence of chronic hand eczema in its different stages of severity and refractoriness to standard therapy in patients accessing Italian dermatological reference centres, and to evaluate sociodemographic and clinical factors associated with each stage. A cross-sectional multicentre study was conducted. Adult patients with hand eczema, consecutively accessing 14 centres over a 6-month period, were enrolled. Patients were classified according to disease duration, severity and response to standard therapy with potent topical corticosteroids. Logistical regression was performed to investigate the relationship between sociodemographic and clinical data with different stages of eczema. The total number of participants was 981. Hand eczema was chronic in 83·5% of patients; 21·3% had severe eczema, with 62·0% of these patients refractory to standard therapy. Food processing and related work, the health professions, craft and related trade works (building, plumbing, electrical), hairdressing/beauty and handicraft work were most frequently associated with chronic hand eczema. Severe chronic hand eczema was more likely to be seen in men, older patients and those with less education. Severe and refractory hand eczema was also more likely among the unemployed and patients with allergic rhinitis and/or atopic dermatitis. Chronic hand eczema is frequent among patients with hand eczema accessing dermatology centres. Many patients were severe and refractory to standard therapy. The appropriate identification of hand eczema is the first step in implementing effective and efficient treatments. © 2014 British Association of Dermatologists.
Hågensli, Niels; Stenvik, Arild; Espeland, Lisen
To examine factors associated with patients' decision to decline surgery. Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Dusi, W; Bollini, D; Moroni, C; Ricard, M
The performance of an improved intraoperative gamma-probe for radioassisted oncological surgery is presented and discussed. The probe is based on a square array of four 5x5 mm sup 2 coplanar CdTe room temperature semiconductor detectors and each detector has an independent read out electronic chain, allowing an original handling of the signal. Therefore, the search for gamma-emission hot points may be carried out in two different, independent ways: (1) Finding out the position of the probe corresponding to the maximum value of the total counting rate, on the basis of a trial and error procedure (typical for the conventional probe; (2) Finding out the position of the probe where both the differences between the counting rate performed by orthogonal, adjacent halves of the array vanish (differential method). This makes the new probe sensitive to the bidimensional gradient of the gamma-ray flux, measured on the scanned plane. Furthermore, the algebraic sign of the difference indicates in which direction the prob...
Julia Navas López
Full Text Available Using socio-anthropological analysis, this paper presents preliminary results of an inter-disciplinary investigation entitled “A nutritional and anthropological study of patients with type III and IV obesity undergoing bariatric surgery.” The medical ethnographic approach employed in this study has two goals: to study patients’ cultural context before and after surgical treatment and to analyze perceptions, representations, social inte-gration, stigmatization, and social control before and after surgery. The results show potential discrimination against these patients based on their group identification and a permissive environment; these ideas are manifested in the concepts of the “obesogenic society” and the “obese victim.” On the other hand, the process of medicalization provides a mechanism capable of both social inclusion and exclusion. The results of this preliminary analysis are informing ongoing work between patients and professionals in this nutritional study.
Langwińska-Wośko, Ewa; Chociszewska-Nitka, Anna; Zielińska, Edyta; Hapunik, Adam
The aim of this study was to evaluate the influence of cataract surgery on the condition of corneal endothelium, in diabetic patients. We examined 103 patients (103 eyes) after cataract surgery (64 women and 39 men), at the age between 49 and 89. In our study we didn't involve any patients with intra or post-surgery complications. Using Specular Microscope SP-1000 corneal endothelium was examined before cataract surgery and in the long-term follow-up: 7, 30 and 90 days after surgery. The patients were divided into two groups: suffering from diabetes (54) and matched control group--non-diabetic patients with cataract (49). The same patients were also divided depending on the type of surgical technique: phacoemulsification (42) or extracapsular cataract extraction (61). The mean percent loss of corneal endothelium cells, due to surgery in diabetic patients was: 11.31% after 7 days, 13.99% after 30 and 15.38% after 90 days. In the control group: 5.45% after 7 days, 8.66% after 30 and 11.33% after 90 days. The mean percent loss of corneal endothelium cells after phacoemulsification was: 10.10% after 7 days, 13.21% after 30 and 15.87% after 90 days; after extra-capsular cataract extraction: 6.84% after 7 days, 9.71% after 30 and 11.48% after 90 days. Differences between mean value of corneal endothelial cells in diabetic patients compared with control group, were statistically essential 7 and 30 days after cataract surgery, and near such assessment 90 days after surgery. There were no statistically essential differences between endothelial cells density in both operated groups, in relation to type of operation (phacoemulsification and extra-capsular cataract extraction). Above results are the evidence, that cataract surgery is a big trauma for cornea, especially for its endothelium. The operation is mainly dangerous for patients suffering from diabetes. The surgeon should be aware of the above threat during cataract surgery in diabetic patients, and therefore should
Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible
Garus-Pakowska, Anna; Sobala, Wojciech; Szatko, Franciszek
According to the Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) recommendations, medical staff are obliged to decontaminate the skin of the hands before every single patient contact. The study was performed by quasi-observation among the group of 188 medical staff (nurses and physicians) working in three selected hospitals of the Łódź province. The procedure of hand washing and disinfection performed directly before the patient contact according to the CDC and WHO recommendations were observed. The results was subject to statistical analysis (p hand washing were recorded. The medical staff obeyed the hand washing procedure before the patient contact only in 5.2% of the situations. There was no activity observed before which hand hygiene was maintained in 100% of cases. Observance of hand hygiene depended significantly on the type of the performed activity, the professional group, and the workload index. A decrease in percentage observance of hand hygiene according to the time of the day was found to be of statistical significance. The mean time of hand washing was 8.5 s for physicians and 6.6 s for nurses. The level of observance of hand washing procedures among the medical staff prior to the patient contact appears to be alarmingly below the expectations.
Full Text Available Introduction: According to the Centers for Disease Control and Prevention (CDC as well as the World Health Organization (WHO recommendations, medical staff are obliged to decontaminate the skin of the hands before every single patient contact. Materials and Methods: The study was performed by quasi-observation among the group of 188 medical staff (nurses and physicians working in three selected hospitals of the Łódź province. The procedure of hand washing and disinfection performed directly before the patient contact according to the CDC and WHO recommendations were observed. The results was subject to statistical analysis (p < 0.05. Results: During 1544 hours of observation 4101 activities requiring hand washing were recorded. The medical staff obeyed the hand washing procedure before the patient contact only in 5.2% of the situations. There was no activity observed before which hand hygiene was maintained in 100% of cases. Observance of hand hygiene depended signifi cantly on the type of the performed activity, the professional group, and the workload index. A decrease in percentage observance of hand hygiene according to the time of the day was found to be of statistical signifi cance. The mean time of hand washing was 8.5 s for physicians and 6.6 s for nurses. Conclusion: The level of observance of hand washing procedures among the medical staff prior to the patient contact appears to be alarmingly below the expectations.
Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. © 2012 Blackwell Publishing Ltd.
Bilge Fettahlıoğlu Karaman
Full Text Available Objective: The patch and prick tests have a place in the management of patients with hand eczema. In this study, we investigated whether some of the clinical features patients with hand eczema could provide us with the predictability of skin test results. Methods: In Çukurova University Faculty of Medicine, 67 consecutive patients with hand eczema; evaluated in terms of duration of disease, morphology and severity. All of the patients were undergoes patch tested with the European Standard Series, and needle testing with routine aeroallergens. Results: Patch test with at least one allergen was positive in 46.3% of the patients; wheras this rate was 23.9% for prick test. The likelihood of having a contact sensitivity of patients complaining of hand eczema for at least three years was statistically more significant [odds ratio (OR 0.9]. Although statistically not significant, it is less likely to be sensitized to patients with keratotic and/or licheniform hand eczema (OR 0.3. The severity of hand eczema was not predictive of patch test, there was no indicator of needle test positivity. Conclusion: We strongly recommend patch testing in all patients with prolonged hand eczema.
Barbara, David W; Mauermann, William J; Neal, James R; Abel, Martin D; Schaff, Hartzell V; Winters, Jeffrey L
Cold agglutinins (CA) are circulating autoantibodies present in most humans. They are active below normal body temperatures. Cold hemagglutinin disease involves the presence of CA sufficiently active at temperatures in the periphery to produce hemolysis or agglutination. Systemic hypothermia and cold cardioplegia may result in agglutination or hemolysis. We reviewed the experience of a large referral center in managing patients with CA and cold hemagglutinin disease undergoing cardiac surgery requiring cardiopulmonary bypass. The electronic medical records from 2002 to 2010 were searched to identify patients with CA or cold hemagglutinin disease who underwent cardiac surgery requiring cardiopulmonary bypass. Information related to preoperative CA testing and treatment, surgery, cardiopulmonary bypass, postoperative complications, and mortality was recorded. Sixteen patients underwent 19 procedures requiring cardiopulmonary bypass. Six patients had cold hemagglutinin disease. The identification of CA was made intraoperatively in 3 patients. One patient underwent preoperative plasma exchange. Cold blood cardioplegia was used in 2 of 16 procedures using cardioplegia, with the remaining using warmer blood cardioplegia. The lowest recorded intraoperative core temperature was less than 34 °C in 1 case. CA-related postoperative hemolysis requiring transfusion was present in 1 patient, which was resolved with active warming. No patient had evidence of permanent myocardial dysfunction, had a neurologic event, required dialysis, or died within 30 days. All patients with CA/cold hemagglutinin disease at the Mayo Clinic College of Medicine safely underwent cardiac surgery without major adverse morbidity or mortality. Patients with CA but without evidence of cold hemagglutinin disease can safely undergo normothermic cardiopulmonary bypass at 37°C and warm cardioplegia without further testing. Patients with cold hemagglutinin disease should undergo laboratory testing including
Zhu, Yaxin; Yan, Tingmei; Qu, Bo
The objective of this study was to assess the competency of surgery residents from the patient perspective in the current healthcare environment in China. The authors performed an assessment of 508 surgery residents in Liaoning province. Seven patients were as a group to complete the self-administered questionnaires on the survey for each individual corresponding resident. A 5-point rating scale with an unable-to-evaluate category was used to assess surgery resident competency by patients. Reliability and validity were assessed by Cronbach alpha (α) and exploratory factor analysis, respectively. Statistical analysis was performed using SPSS 13.0. The surveys on 421 residents were valid, and the valid response rate was 82.8%. A total of 2947 questionnaires from patients were analyzed in this study. The Cronbach α coefficient was 0.92. The 4 factors emerging in the exploratory factor analysis reached a cumulative contribution rate of 66.98%. The items of "promotes health maintenance (talks about preventive care)" (206/7.0%), "tells me about any side effects of the medicine" (177/6.0%), "spends enough time with me" (189/6.4%), and "answers my questions thoroughly" (168/5.7%) were scored <4 by higher percentage of patients. The instrument provided an acceptable means for patients to evaluate the competency of Chinese surgery residents. Surgery residents should improve their competencies on preventive care, patient safety, and communication skills.
Chu, Michael W; Cook, Julia A; Tholpady, Sunil S; Schmalbach, Cecelia E; Momeni, Arash
Patient education is essential in enhancing the physician-patient therapeutic alliance, patient satisfaction, and clinical outcomes. The American Medical Association and National Institute of Health recommend that information be written at a 6th-grade reading level, but online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial plastics procedures presented on academic plastic surgery and otolaryngology websites.An Internet search was performed of all academic institutions that had both plastic surgery and otolaryngology training programs who offered patient information on facial plastic surgery procedures. National society websites for both plastic surgery and otolaryngology were also analyzed. All procedural information was compiled and readability analyses were performed. A 2-tailed Z-test was used to compare scores, and statistical significance was set at P material. The overall average readability for all information was at a 10th-grade reading level. The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (P materials are a potential hindrance to patient education, satisfaction, and decision making. Healthcare institutions should consider writing new materials with simpler language that would be accessible to patients.
Fujikado, Takashi; Morimoto, Takeshi; Shimojyo, Hiroshi
Anisometropia is reported to increase with age; however, the relationship between the development of anisometropia and binocular vision has not been determined. The purpose of this study was to determine the relationship between anisometropia and binocular vision after esotropia (ET) surgery. The medical records of 51 consecutive patients with ET who had undergone ET surgery were studied. Patients with amblyopia or anisometropia ≥2 diopters (D) before surgery were excluded. The average age of the patients at the time of surgery was 4.5 ± 3.7 years, and the average postoperative period was 5.0 ± 2.2 years. The refractive errors (spherical equivalent) in both eyes were measured preoperatively and postoperatively. Binocular visual function was evaluated with a modified Worth-4 dot test. At the final visit, average anisometropia was 0.98 ± 1.30 D, which was significantly greater than the preoperative value of 0.36 ± 0.46 D (P Anisometropia ≥2 D was observed in ten patients (23%) postoperatively. One patient was able to fuse a target of ≥2° (10%) in the anisometropia ≥2 D group, significantly fewer than the 13 patients (32%) in the anisometropia Anisometropia may develop in patients with poor sensory fusion after surgery for esotropia.
Chen, Catherine L; Lin, Grace A; Bardach, Naomi S; Clay, Theodore H; Boscardin, W John; Gelb, Adrian W; Maze, Mervyn; Gropper, Michael A; Dudley, R Adams
Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing. Using an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit. Of 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient's probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation. Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.).
Mehaffey, J Hunter; Michaels, Alex D; Mullen, Mathew G; Meneveau, Max O; Pender, John R; Hallowell, Peter T
Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers. This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery. Patients who underwent Roux-en-Y gastric bypass at an academic bariatric surgery center from 1985 to 2004 were examined and stratified by patient travel distance. Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-yr) weight loss between "local," defined as1 hour of travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models. A total of 650 patients underwent Roux-en-Y gastric bypass, of whom 316 (48.6%) traveled1 hour. Median body mass index was equivalent between the groups (local, 52.9 kg/m2; regional, 53.2 kg/m2; P = .76). Patients who traveled longer distances had higher rates of preoperative co-morbidities, including chronic obstructive pulmonary disease, congestive heart failure, diabetes, and sleep apnea (all P1 hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent with that of local patients. As expected, patients who lived in close proximity were more likely to adhere to yearly follow-up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Purpose: To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patientsMethods: One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-conﬁdence, and self-assessment of intelligence, employment and interpersonal relationships were compared.Results: Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values. More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values.Conclusion: Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.
Yang, Hui; Zhao, Xiaoyun; Tang, Shan; Huang, Hua; Zhao, Xiulan; Ning, Zhuohui; Fu, Xiurong; Zhang, Caihong
Laryngeal cancer is a common malignancy; surgery is the preferred treatment. Psychosocial stress is one of the negative impacts on patient recovery. This study aimed to elucidate the effect of probiotics on ameliorating anxiety, and on serum corticotropin-releasing factor (CRF) in laryngeal cancer patients before surgery. A total 30 patients with laryngeal cancer and 20 healthy volunteers were recruited. During the 2 weeks before surgery, 20 patients were randomly allocated to receive probiotics or placebo twice a day. Heart rate was recorded daily. The degree of anxiety was assessed by the Hamilton Anxiety Scale (HAMA). Serum CRF levels in laryngeal cancer patients increased significantly in approaching surgery. After ingestion of probiotics, serum levels of CRF and heart rate did not increase before surgery. In addition, taking probiotics relieved the degree of anxiety of the patients from HAMA 19.8 to 10.2. Probiotics can ameliorate the clinical anxiety and biochemical features of stress in patients scheduled for laryngectomy. © 2014 Wiley Publishing Asia Pty Ltd.
Eghrari, Allen O; Rivers, Richard J; Alkharashi, Majed; Rajaii, Fatemeh; Nyhan, Daniel; Sikder, Shameema
Left ventricular assist devices (LVADs) have been increasingly used for 20 years in terminally ill patients with advanced heart failure or awaiting cardiac transplantation. Despite improvement in morbidity and mortality from use of these devices, quality of life may be limited by cataract. Access to cataract surgery in this predominantly elderly population is essential but limited by unfamiliarity with these devices. We describe phacoemulsification and intraocular lens implantation in 2 patients with LVADs. The patients had extensive preoperative cardiology evaluations and were instructed to continue warfarin through the day of surgery. Monitored sedation was used with fentanyl and midazolam. Both patients experienced significant improvement in visual acuity and quality of life. Neither experienced intraoperative hemodynamic instability. Cataract surgery may be safely performed in patients with LVAD support when adequate monitoring resources are available. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Fisher, Carolyn J; Heinberg, Leslie J; Lapin, Brittany; Aminian, Ali; Sullivan, Amy B
Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery. Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS). There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08). Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.
Tan, Kok-Yang; Tan, Phyllis; Tan, Lawrence
We hypothesized that a dedicated collaborative transdisciplinary Geriatric Surgery Service (GSS) will improve care for elderly colorectal surgery patients. Patients older than 75 years of age who underwent major colorectal surgery were included in this study. The Geriatric Surgery Service employed a transdisciplinary, collaborative model of care. There were frequent quality reviews and a patient-centered culture was ensured. Treatment protocols and checklists were instituted. Perioperative outcome data were collected prospectively between 2007 and 2009. These data were compared to those from similar patients not managed by the service. Success and failure of surgical treatment of the two groups were analyzed using CUSUM methodology. Failure was defined as mortality, prolonged hospital stay for any reason, including morbidity, and failure to regain preoperative function by 6 weeks. Twenty-nine patients managed by the GSS were compared to 52 patients who underwent standard treatment. The median age of the patients managed by the GSS was higher but there was no difference in the ASA score and predicted morbidity scores based on the POSSUM model. The GSS achieved lower mortality and major complication rates. A large majority (84.6%) of the patients managed by the GSS returned to preoperative functional status by 6 weeks. The GSS was able to produce a trend of successively desired outcomes consistently leading to the CUSUM curve exhibiting a sustained downward slope. This was in contrast to patients not managed by the GSS. The Geriatric Surgery Service, through its transdisciplinary, collaborative care processes, was able to achieve sustained superior outcomes compared to standard management.
Park, Sangwoo; Bishop, Lauri; Post, Tara; Xiao, Yuchen; Stein, Joel; Ciocarlie, Matei
Fully wearable hand rehabilitation and assistive devices could extend training and improve quality of life for patients affected by hand impairments. However, such devices must deliver meaningful manipulation capabilities in a small and lightweight package. In this context, this paper investigates the capability of single-actuator devices to assist whole-hand movement patterns through a network of exotendons. Our prototypes combine a single linear actuator (mounted on a forearm splint) with a...
Lai, Eddie Hsiang-Hua; Liu, Jen-Pei; Chang, Jenny Zwei-Chieng; Tsai, Shih-Jaw; Yao, Chung-Chen Jane; Chen, Mu-Hsiung; Chen, Yi-Jane; Lin, Chun-Pin
The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals. Methods: The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and ...
Lessing, Noah L; Edwards, Charles C; Brown, Charles H; Ledford, Emily C; Dean, Clayton L; Lin, Charles; Edwards, Charles C
Spinal anesthesia is increasingly viewed as a reasonable alternative to general anesthesia for lumbar spine surgery. However, the results of spinal anesthesia in elderly patients undergoing lumbar spine decompression and combined decompression and fusion procedures are limited in the literature. The aim of this study was to report a single institution's experience using spinal anesthesia in elderly patients undergoing lumbar spine surgery. A retrospective review was conducted using a prospectively collected database of consecutive lumbar spine surgeries performed under spinal anesthesia in patients 70 years or older at a single center between December 2013 and October 2015. A total of 56 patients were included in the study; 27 patients (48%) underwent lumbar decompression and 29 patients (52%) underwent combined decompression and fusion procedures. Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, 1-10). Nausea occurred in 21% (12 of 56) of the patients. Mean length of stay was 2.4 days (range, 1-6 days). No mortality, stroke, permanent loss of function, or pulmonary embolism occurred. None of the cases required conversion to general anesthesia. All of the patients were ambulatory on either the day of the surgery or the next morning. These results demonstrate that spinal anesthesia is a viable method of anesthesia for patients 70 years and older undergoing lumbar spine surgery. They also demonstrate the safety of this method for patients older than 84 years and for surgeries lasting up to 3½ hours. [Orthopedics. 2017; 40(2):e317-e322.]. Copyright 2016, SLACK Incorporated.
Szczegielniak, Jan; Łuniewski, Jacek; Bogacz, Katarzyna; Sliwiński, Zbigniew
Rheumatoid arthritis (RA) most frequently affects smaller joints in the hands and feet. Among the most common deformations resulting from the progression of the disease are ulnar deviation, Boutonniere deformity, swan neck deformity, contractures and limited range of movement in the hand and wrist joints, muscular atrophy of long and short muscles. The topic of this article is the influence of using Kinesiology Taping method on the functioning of the hand of the patient suffering from rheumatoid arthritis. The research involved 20 patients suffering from rheumatoid arthritis (16 women, 4 men), treated in the Hospital in Kup. Average age of patients was 62.2. Research subjects, apart from pharmacological treatment in the hospital ward, received standard physiotherapy. In case of 10 patients additional K-Active Tape applications were used to correct ulnar positioning of the hand and improve hand functioning. Prior to physiotherapy, all patients were given a hand functioning test and a dynamometer measurement was made. The tests were repeated after the 2-week rehabilitation process has been completed. The results were subjected to statistical analysis with the use of the Wilcoxon test and the U Mann-Whitney test. The assessment of the correlation between analysed parameters was made with the use of linear correlation test. In the group where Kinesiology Tape applications were used, hand muscle strength increased significantly (p0.8). Results suggest Kinesiology Taping method useful for physiotherapy of rheumatoid hand.
Full Text Available Background: Even if permanent atrial fibrillation (pAF is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56 with pAF (≥6 months underwent either monopolar (Group A, B: n=51 vs. n=44 or bipolar (Group A, B: n=19 vs. n=12 radiofrequency (RF ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA class and conversion rate to stable sinus rhythm (SR. Results: Early mortality (<30 days was 2.9% in Group A (Group B: 0%, cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03 and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%. Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age.
Yahya, Ayesha; Malarkey, Andrew R; Eschbaugh, Ryan L; Bamberger, H Brent
Cubital tunnel syndrome is the second most common compression neuropathy affecting the upper extremity. The aim of this study was to determine the preferred surgical treatment for cubital tunnel syndrome by members of the American Society for Surgery of the Hand (ASSH). We invited members of the ASSH research mailing list to complete our online survey. They were presented with 6 hypothetical cases and asked to choose their preferred treatment from the following options: open in situ decompression, endoscopic decompression, submuscular transposition, subcutaneous transposition, medial epicondylectomy, and conservative management. This was assessed independently and anonymously through an online survey (SurveyMonkey). 1069 responses were received. Seventy-three percent of the respondents preferred to continue conservative management when a patient presented with occasional paresthesias for greater than 6 months with a normal electromyogram (EMG) or nerve conduction velocity (NCV). Sixty-five percent picked open in situ decompression if paresthesias, weakness of intrinsics, and EMG/NCV reports of mild to moderate ulnar nerve entrapment was present. More than 50% of respondents picked open in situ decompression, as their preferred treatment when sensory loss of two-point discrimination of less than 5 or more than 10 was present in addition to the findings mentioned above. Seventy-nine percent of the respondents said their treatment algorithm would change if ulnar nerve subluxation was present. Our survey results indicate that open in situ decompression is the preferred operative procedure, if there is no ulnar nerve subluxation, among hand surgeons for cubital tunnel syndrome.
Seyed Kazem Shakuri
Full Text Available Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B. In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results — Thirty nine of males (65% and 21 females (35% with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7 and predicted peak flow indices (CI95%: 1.9 to 9.4 of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0 and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67 in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion — Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.
A, Roohi Sharifah; Abdullah, Shalimar
A report on the 10(th) Asia-Pacific Federation of Societies for the Surgery of the Hand and 6(th) Asia-Pacific Federation of Societies for Hand Therapists is submitted detailing the numbers of attendees participating, papers presented and support received as well the some of the challenges faced and how best to overcome them from the local conference chair and scientific chair point of view.
SILVEIRA-JÚNIOR, Sérgio; de ALBUQUERQUE, Maurício Mendes; do NASCIMENTO, Ricardo Reis; da ROSA, Luisa Salvagni; HYGIDIO, Daniel de Andrade; ZAPELINI, Raphaela Mazon
Background Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. Aim To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. Method A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. Results The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. Conclusions Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight. PMID:25861070
Susan E. Williams
Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.
Background: One in four patients with radiculopathy experience persistent pain and disability after lumbar surgery. Postoperative rehabilitation for lumbar radiculopathy has shown little effect on reducing pain and disability. Previous research provides evidence for Neuroscience Education (NE) as a way to decrease pain, disability and fear avoidance before surgery. Methods: A multiple Single Subject Experimental Design (SSED) with six participant was completed at Martina Hansen Hospital in No...
Full Text Available A new patient adaptable dual use soft tissue spreader and cerebellar retractor system designed for use during surgery of the posterior fossa is described. We found that this new retractor design allowed for excellent exposure, plus greater freedom and dexterity during the posterior fossa surgery. This novel instrument is an improvement over the existing instrument, because it provided more force/power transmission from pins/connectors to the brain spatula via the shorter flexible arm.
Zalewsky, S; Vinker, S; Fiada, I; Livon, D; Kitai, E
Music is a universal language, and its effects on pain relief and stress reduction are well known. We evaluated patients' opinions of the effects of background music in their family doctors' surgery. Low volume, background, classical music was played in the doctors' surgery on 5 consecutive clinic days. All patients were asked to fill a short anonymous questionnaire on leaving. Among the 135 consecutive patients offered the questionnaire, there was 87.4% compliance. Among the 118 who completed the questionnaire, 95% said that the background music did not disturb them, 89% thought it made them feel better and 80% thought that it aided the doctor's performance. We conclude that low volume, background music in the doctors's surgery may contribute to better doctor-patient interaction, although larger studies are needed to confirm our findings.
Ferree, Steven; van der Vliet, Quirine M J; van Heijl, Mark; Houwert, Roderick M; Leenen, Luke P H|info:eu-repo/dai/nl/071390596; Hietbrink, Falco|info:eu-repo/dai/nl/304821713
INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence,
Ronchi, Roberta; Heydrich, Lukas; Serino, Andrea; Blanke, Olaf
The symptoms of patients with left personal neglect are characterized by inattention towards contralesional (left) body parts while at the same time explicitly ascertaining ownership for the neglected hemibody. It is currently unknown if personal neglect is associated with more subtle or implicit disturbances of own body perception and body ownership as measured with the rubber hand illusion. In this study, we report data from a patient with a right hemispheric lesion and personal neglect, without associated somatosensory deficits. We administered to the patient (and to 12 age-matched controls) the rubber hand illusion paradigm to the right and left hands, to elicit illusory ownership for a fake hand, before and after recovery from personal neglect for the left arm. In a first session, run when the patient showed personal neglect affecting the left arm, he experienced a significantly enhanced subjective illusion of embodiment for the left fake hand as compared to the right hand (as assessed through a standard questionnaire). After recovery from personal neglect for the left arm (second session), the results of the left and right rubber hand illusion experiments were comparable, with no modulation of hand ownership. We argue that personal neglect may consist not only in an inattentional disorder, but also in a deficit of multisensory body representation characterized by a high sensitivity to experimental manipulations of subjective aspects of body ownership. © 2017 The British Psychological Society.
Aldairy, T; Laverick, S; McIntyre, G T
The aims of this study were to evaluate the quality and reliability of UK websites providing information on orthognathic and jaw surgery to patients. An Internet search engine (www.google.com) was used to identify websites containing medical information on 'orthognathic surgery' and 'jaw surgery'. Of over 144,000 links for orthognathic surgery and 700,000 for jaw surgery, the first 100 were examined in detail. After excluding discussion groups, news and video feeds, and removing duplicate sites, only 25 relevant websites remained which were then evaluated using the DISCERN instrument (www.discern.org.uk/discern_instrument.php). Through the 16 questions assessing the reliability and quality of the consumer information which are scored from 1 to 5, a relative index of the quality of the information is produced. The maximum score attainable for an excellent website is 80. Of the 25 websites that were scored, DISCERN indicated the majority of websites fell well below the maximum score. The highest score achieved by one of the websites according to the DISCERN tool was 64 of 80 and the lowest score achieved was 21 of 80. The websites achieving maximum and minimum score were Wikipedia and qualitydentistry.com, respectively. By directing patients to validated websites, clinicians can ensure patients find appropriate information; however, further development of websites relating to orthognathic surgery is required. Internet information should be updated on a regular basis to account for improvements in orthodontic and surgical care.
Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.
Magro-Filho, Osvaldo; Goiato, Marcelo Coelho; Oliveira, Derly Tescaro Narcizo; Martins, Lidia Pimenta; Salazar, Marcio; Medeiros, Rodrigo Antonio De; Santos, Daniela Micheline Dos
Well-planned orthognathic surgery improves psychological health, aesthetics and function of patients. The present study aimed to investigate patients' satisfaction after orthognathic surgery by means of a satisfaction questionnaire before and after surgery. A total of 29 patients was selected (17 women and 12 men), with a mean age of 28 years, randomly selected from a private clinic at Araçatuba - São Paulo by two investigators. Anamnesis and clinical examination were performed. Subjects with facial deformities submitted to orthodontic treatment before and after orthognathic surgery with a minimum post-surgery period of 6 months, answered a satisfaction questionnaire composed of 10 questions regarding dental and facial aesthetics. In this study, the maximum satisfaction score was 10. Regarding aesthetics, two satisfaction parameters were investigated: dental and facial. For all indices, the average satisfaction was up to score 7. According to the results, it can be concluded that orthognathic surgery has been an effective treatment for dentofacial deformities, aesthetics and functional problems, what was verified by pre and postoperative questionnaire application.
Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.
Ahmad, Meleha; Chocron, Isaac; Shrivastava, Anurag
Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.
Ana Catarina Alves e Silva
Full Text Available OBJECTIVE: To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. METHODS: A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. RESULTS: The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. CONCLUSION: Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.
Austvoll-Dahlgren, Astrid; Underland, Vigdis; Straumann, Gyri Hval; Forsetlund, Louise
BACKGROUND Patient volume is assumed to affect quality, whereby complex procedures are best performed by those who perform them frequently. We have conducted a systematic review of the research on the association between patient volume and quality of vascular surgery. In this article we describe the outcomes for abdominal aortic aneurysm surgery.MATERIAL AND METHOD We undertook systematic searches in relevant databases. We searched for systematic reviews, and randomised and observational studies. The search was concluded in December 2015. We have summarised the results descriptively and assessed the overall quality of the evidence.RESULTS Forty-six observational studies fulfilled our inclusion criteria. We found a possible association for both hospital and surgeon volume. Higher patient volume may possibly be associated with lower 30-day mortality and lower hospital mortality for both open and endovascular surgery. Although the association appears to apply to both elective and acute hospitalisations, there is greater uncertainty with regard to the most ill patients. For hospital volume there may also be fewer complications for open and endovascular surgery, as well as for all surgery assessed as a whole. We considered the evidence base to be medium to very low quality.INTERPRETATION We found a possible correlation between patient volume and quality indicators such as mortality and complications. It may be advantageous to allocate planned procedures to institutions and surgeons with high volume, while this is less certain with regard to acute hospitalisations.
D. I. Kutyanov
Full Text Available Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases or free tissue transfer (45 cases. 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%. In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%. Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.
early sepsis or postoperative inotropic requirements may, however, result in early troponin release, .... failure. Emergency surgery was performed in 17.8% of the patients and this was associated with a ... septic shock.17 There were four patients (11.4%) in our MINS group that had coexisting sepsis during the first three days ...
Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J
To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.
Kurbanov, F S; Abbasova, S F; Dobrovol'skiĭ, S R; Sushko, A N; Ramazanova, A R
43 patients aged 60-84 years were operated on calculous cholecystitis. Patients were divided according to the operative technique: laparoscopic and traditional. The laparoscopic cholecystectomy demonstrated good early results. The goal of the study was to define criteria of the elderly patients selection for the laparoscopic operation.
Yang, Mengchang; Su, Wenjie; Deng, Xiaofan; Deng, Jia; Li, Peng; Li, Xiangkui
Hepatic alveolar echinococcosis (HAE) is a severe and common parasitic disease in Tibetan Plateau of China. The infected patients have to move to plain areas to receive treatments due to the poor medical conditions in plateau areas. Our aim was to investigate the application of Enhanced Recovery after Surgery (ERAS) program in perioperative management for HAE patients from Tibet Plateau and the notes for patients with landform changes. A total of 89 HAE patients from Tibet Plateau (altitude: average of 4500 m) prior received adaptive treatments at the cooperative hospital (altitude: 1500-2000 m) and accepted surgery at plain regions (altitude: 200-400 m). The patients in ERAS group received ERAS program care and patients in conventional management group received conventional care during perioperative period. Patients in ERAS group displayed significant shorter hospital stay and shorter time for recovery of gurgling compared with conventional management group (ERAS group versus conventional management group: 10.48 ± 3.525 d versus 20.29 ± 8.632 d; 1.56 ± 1.236 d versus 2.8 ± 1.19 d; all P Plateau need to receive adaptive treatments for landform changes before receiving surgeries at plain regions. ERAS program is effective and safe for Tibetan HAE patients during perioperative period. Copyright © 2017 Elsevier Inc. All rights reserved.
Lemaitre, S; Blumen-Ohana, E; Akesbi, J; Laplace, O; Nordmann, J-P
Preoperative anxiety is often expressed by patients requiring filtration surgery for their glaucoma. So far, there has been no scale for screening this group of patients for preoperative anxiety. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-evaluation questionnaire which has been used in specialties other than ophthalmology and which makes it possible to identify the adult patients with a high level of preoperative anxiety over an upcoming surgical procedure. The purpose of this study is to estimate the preoperative anxiety in glaucoma patients requiring filtration surgery. We performed a prospective study of 36 adult patients with chronic glaucoma not responding to medical treatment and who were about to undergo filtration surgery (trabeculectomy or deep sclerectomy). The APAIS questionnaire was given to the patients after discussing the indication for surgery. A global anxiety score (ranging from 4 to 20) above 10 defined patients with a high level of preoperative anxiety. We attempted to identify among these patients the factors related to filtration surgery which caused them anxiety (lack of control of intraocular pressure, risk of blindness, presence of the filtering bleb). In our sample of patients, we found that glaucoma was a source of anxiety. That was also true for the surgical procedure, though most patients believe that once the decision had been made, their psychological status was not modified by the upcoming procedure. The patient-clinician relationship is important in any chronic disease, all the more so in glaucoma, since this disease remains asymptomatic for a long time. When filtration surgery is necessary, the patients are going to express less preoperative anxiety if they trust their physician and if individualized information has been given to them The French version of the APAIS is a quick scale, easily completed, that can be recommended for evaluating anxiety and patients' need for information prior to filtering
Dupim Souza, Ana Carolina; Franco, Carolina F; Pataro, André L; Guerra, Tadeu; de Oliveira Costa, Fernando; da Costa, José Eustáquio
Patients undergoing bariatric surgery often complain of bad breath. However, the relationship between bariatric surgery and halitosis is relatively unknown. The purpose of the present study was to evaluate and compare the occurrence of halitosis among patients before and after a specific type of bariatric surgery, Roux-en-Y gastric bypass, and its relationship with the tongue coating index, plaque index, and salivary flow rate. A total of 62 patients with good oral health and in treatment for obesity at the walk-in clinic of Santa Casa Hospital, Belo Horizonte, Brazil, were selected. Of this sample, 31 were bariatric surgery candidates (control group) and 31 had already undergone Roux-en-Y gastric bypass surgery (case group). After completing a questionnaire, all patients underwent an oral clinical examination. Halitosis was measured using an organoleptic scale and a portable sulfide monitor. The Spearman correlation demonstrated a strong positive relation between the organoleptic rates and the concentration of volatile sulfur compounds determined using the sulfide monitor (rs = .58; P = .0001). No difference was found in the prevalence of halitosis between the 2 groups (P = .48). Only the salivary flow rate was significantly reduced in the control group compared with the case group (P = .02). In the case group, the concentration of volatile sulfur compounds correlated negatively with the salivary flow rate (P = .04) and positively with the tongue coating index (P = .005). The tongue coating index was significantly increased in those patients who did not brush the tongue (P halitosis and Roux-en-Y gastric bypass. However, they do highlight the possible effect of this surgery on the oral cavity. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males. A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%. The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.
Pringle, M; Robins, S; Brown, G
A postal survey sent to 350 patients from two rural practices confirmed that an appreciable minority of patients (17%) were opposed to doctors using computers. The questionnaire distributed had been carefully designed to identify their opposition more specifically. Most of the general concern was accounted for by the 91 patients (31%) who feared that confidentiality of information would be reduced. The sensitive nature of medical information alerts patients to the possibility of diminished security of records and obliges practices considering acquiring a computer to ensure that these fears are not realised. Smaller proportions of patients were found to oppose computers on other grounds--namely, impersonality, economy, and general anxiety. PMID:6419902
Harrison, W J; Lewis, C P; Lavy, C B D
We performed a prospective, blind, controlled study on wound infection after implant surgery involving 41 procedures in patients infected with the human immunodeficiency virus (HIV) and 141 in HIV-negative patients. The patients were staged clinically and the CD4 cell count determined. Wound infection was assessed using the asepsis wound score. A risk category was allocated to account for presurgical contamination. In HIV-positive patients, with no preoperative contamination, the incidence of wound infection (3.5%) was comparable with that of the HIV-negative group (5%; p = 0.396). The CD4 cell count did not affect the incidence of infection (r = 0.16). When there was preoperative contamination, the incidence of infection in HIV-positive patients increased markedly (42%) compared with that in HIV-negative patients (11%; p = 0.084). Our results show that when no contamination has occurred implant surgery may be undertaken safely in HIV-positive patients.
Gonser, P; Medved, F; Schaller, H-E; Lotter, O
The Institute for Reimbursements in Hospital (InEK) annually provides an updated DRG system to ensure the medical service providers with a cost-covering remunera-tion. However, the underlying cost data are often opaque and disclosure of the basis of calculation does not take place. On the basis of cost and revenue data from our clinic between 2010 and 2012, a profit statement for amputations and replantation of one or more fingers was employed and compared with the nationwide data of the calculation clinics. Inpatient days, the revenue and the costs incurred in our clinic based on the cost matrix of InEK costing manual  were determined for amputation (DRG X05B), replantation of one (DRG X07B) and several fingers (DRG X07A). The profit was calculated as the difference between revenues and costs. Further-more, a comparison of our data with the nationwide data of InEK was applied. For each of the 3 DRGs the actual costs in our clinic were higher than the costs generated by InEK. Only amputation appeared profitable, while all limb-preserving interventions were associated with losses for our hospital. There was a clear discrepancy between the data of cost of InEK GmbH to the data of our clinic. In order not to create any monetary disincentives at the expense of quality of care of individual patients, a cost-covering patient care for all case groups mentioned above should be ensured. The general distrust in the InEK's data that results from such a discrepancy in the cost data can only be rebutted by increasing transparency and disclosure of the calculation basis. © Georg Thieme Verlag KG Stuttgart · New York.
Regardt, Malin; Schult, Marie-Louise; Axelsson, Yvonne; Aldehag, Anna; Alexanderson, Helene; Lundberg, Ingrid E; Henriksson, Elisabet Welin
The aim of the present study was to develop a 12-week hand exercise intervention for patients with polymyositis (PM) and dermatomyositis (DM) and evaluate adherence, patients' opinions of the programme design and overall feasibility, and the effect on hand function and activity limitation after the intervention. A pilot hand exercise intervention was conducted on a convenience sample of 15 patients with reduced handgrip strength and established, inactive PM and DM. Acceptable adherence was set at 75%. The programme was evaluated based on patients' opinions regarding exertion, the movements involved and overall feasibility. Hand- and pinch-grip strength, grip ability, dexterity and activity limitation were assessed. Eleven of 15 patients completed the intervention, with acceptable adherence of 78-100%. Measures of handgrip strength, dexterity and activity limitation were reduced at baseline compared with normative data from the literature. Throughout the intervention, rates of perceived exertion were scored between 'moderate' and 'fairly strong'. Finger abduction and adduction were excluded from the hand exercise programme because they were not feasible to perform. Repetitions of the exercise increased gradually to a maximum of 30 per movement. Patients regarded this as too time-consuming and suggested ten repetitions daily or 10-20 repetitions 2-4 times per week. There were some individual, clinically meaningful improvements in hand function and activity limitation. A comparison between baseline and after the intervention showed that the three-jaw (tripod) pinch-grip strength (left hand) had increased (p hand exercise programme was found to be feasible to perform by patients with established PM or DM. The effect was limited, with few individual improvements in hand function and activity limitation, indicating a need to increase the resistance in the movements and to limit the duration of each exercise session. Copyright © 2014 John Wiley & Sons, Ltd.
Mulkens, Sandra; Bos, Arjan E R; Uleman, Richard; Muris, Peter; Mayer, Birgit; Velthuis, Peter
During the past decades, cosmetic surgery has become increasingly popular. People with certain psychopathology disorders, for example, body dysmorphic disorder (BDD), are dissatisfied with their physical appearance, and a significant number try to receive cosmetic medical treatment for their complaints. It seems relatively easy for them to receive this type of surgery, despite the fact that it has no or even adverse effects on the symptoms. The present study aimed to investigate the psychological condition and especially the presence of psychopathological symptoms such as BDD in cosmetic surgery patients. Questionnaires about body image dissatisfaction, symptoms of BDD and psychopathology in general and satisfaction about surgery were sent to patients who had been treated in a large cosmetic surgery clinic. Of the patients who replied, 86% were pleased with the outcome of the cosmetic procedure. Further, 21-59% of these former patients scored higher on questionnaires of body image dissatisfaction and psychopathological symptoms than a norm group from the general population. When differentiating the group on the basis of BDD symptomatology, it appeared that the high BDD symptomatic group displayed significantly worse outcome on all measurements. That is, high BDD symptomatic patients were more dissatisfied about the result of surgery, exhibited higher levels of psychopathology, and had lower self-esteem than the low symptomatic BDD patients. These findings clearly suggest that the evaluation of the psychological condition and motivation of the candidate patient might be a valuable addition to the standard procedure in cosmetic medical treatment settings. Copyright Â© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Davies, Emma C; Pineda, Roberto
To investigate intraoperative complications, postoperative findings, and visual acuity outcomes in patients with retinal dystrophy after cataract surgery. Retrospective chart review at an academic tertiary referral centre. Thirty eyes from 18 patients with retinitis pigmentosa and other retinal dystrophies (Usher syndrome, Refsum disease, and Leber congenital amaurosis) who underwent cataract surgery were identified by searching the electronic medical record system from January 2010 to September 2015 for all patients treated by a single physician with billing codes for retinal dystrophy and cataract surgery. Cases were reviewed to determine indication for surgery, intraoperative complications, postoperative findings, preoperative visual acuity, 1-month postoperative visual acuity, and patient subjective satisfaction. Mean best-corrected visual acuity significantly improved after cataract surgery, from 1.09 ± 0.69 preoperatively to 0.614 ± 0.448 at 1 month postoperatively, on logMAR scale (p = 0, Wilcoxon test). The most common postoperative finding was posterior capsule opacification in 20 eyes (66.7%). Visually significant cystoid macular edema occurred in 4 eyes (13.3%) despite the postoperative eye drop regimen. Patient satisfaction at 1 month postoperatively was noted as 93.3% (28 eyes) and attributed mostly to improved central vision and reduced glare symptoms. Patients with visually significant cataract in association with retinal dystrophy have significantly improved best-corrected visual acuity after cataract surgery and report subjectively improved visual functioning. This study confirms that several risks factors are greater in patients with retinal dystrophy, including zonular weakness, posterior capsular opacification, and cystoid macular edema, compared with the general cataract population. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Full Text Available Milos Brodak, Jan Tomasek, Jaroslav Pacovsky, Lukas Holub, Petr Husek Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.Methods: The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.Results: The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22% complications were recorded. The most serious were as follows: one patient (<0.5% died; and four (<2% patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.Conclusion: Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease. Keywords: urinary tract, aged, postoperative complications, Dindo–Clavien classification
Kozian, Alf; Schilling, T; Strang, C; Hachenberg, T
This review presents an overview of the different problems and challenges after thoracic surgery. It covers the pathophysiological changes that may occur regularly in the early and late period following surgery. In addition, surgical complications with anesthesiological implications for diagnosis, treatment and prevention are discussed, and consequences for anesthesia in further major and thoracic surgical procedures are shown. During the last decade, complications in the early period following surgery after thoracotomy have increasingly moved into the focus caused by their high morbidity and mortality. These problems, such as hemorrhagia and bronchopleural fistulas, are important because they call for a prompt revision or even an emergency operation. The therapy of acute bleeding follows general anesthesiological guidelines whereas the bronchopleural fistula demands methods to prevent aspiration pneumonia as a first priority. In the late period following surgery, typical cardiac and pulmonary modifications can be described that persist and have anesthesiological implications in the case of further surgery. Recent literature, however, lacks clear recommendations regarding anesthesiological management and practice for these cases. Current literature presents no general recommendations on how to manage patients after recent thoracic surgery. Therefore it is necessary to find an individual strategy to handle possible complications and well known pathophysiological changes. Knowledge and understanding of the etiology, the pathophysiology and the risk factors of the perioperative period, allows prevention and target intervention aimed at reducing morbidity and mortality following surgery.
Conclusion: Mini-laparoscopic surgery for patients with endometriosis is safe. Group C exhibited decreased postoperative incisional pain, and the procedure used was less invasive and produced superior cosmetic results. However, operating time in Group C was significantly longer. The procedure that Group B underwent was also minimally invasive with a similar operating time and improved cosmetic appearance.
Bekkers, Stijn; Becker, Stéphanie J. E.; Bossen, Jeroen K. J.; Mudgal, Chaitanya S.; Ring, David; Vranceanu, Ana-Maria
Introduction: Patient interpretation of advice from hand therapists may be related to nonadaptive pain thoughts (automatic, overprotective, unduly pessimistic statements triggered by nociception and exacerbated by psychological distress). Purpose of the study: This study aimed to determine whether
Karimi, Kian; Adamson, Peter
Advances in health, increased awareness of preventative medicine, and evolution have led to an increasingly older population worldwide. Surgical aesthetic facial rejuvenation has become increasingly popular, more accessible, and has lost much of the stigma that it once carried. This review will discuss proper patient analysis and selection for aging face surgery, including medical, anatomic, and psychosocial factors that are involved. Although the novice facial plastic surgeon typically focuses on facial analysis and operative techniques in aging face surgery, we caution that the patient's expectations, psychosocial comorbidities, and perioperative interpersonal experiences are the most important factors that yield patient satisfaction, which is the prime outcome that is meaningful in elective cosmetic surgery. © Thieme Medical Publishers.
Basora Macaya, M
Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
Smith, Andrew K; Shara, Nawar M; Zeymo, Alexander; Harris, Katherine; Estes, Randy; Johnson, Lynt B; Al-Refaie, Waddah B
Regionalization of complex surgeries has increased patient travel distances possibly leaving a substantial burden on those at risk for poorer surgical outcomes. To date, little is known about travel patterns of cancer surgery patients in regionalized settings. To inform this issue, we sought to assess travel patterns of those undergoing a major cancer surgery within a regionalized system. We identified 4733 patients who underwent lung, esophageal, gastric, liver, pancreatic, and colorectal resections from 2002-2014 within a multihospital system in the Mid-Atlantic region of the United States. Patient age, race and/or ethnicity, and insurance status were extracted from electronic health records. We used Geographical Information System capabilities in R software to estimate travel distance and map patient addresses based on cancer surgery type and these characteristics. We used visual inspection, analysis of variance, and interaction analyses to assess the distribution of travel distances between patient populations. A total of 48.2% of patients were non-white, 49.9% were aged >65 y, and 54.9% had private insurance. Increased travel distance was associated with decreasing age and those undergoing pancreatic and esophageal resections. Also, black patients tend to travel shorter distances than other racial and/or ethnic groups. These maps offer a preliminary understanding into variations of geospatial travel patterns among patients receiving major cancer surgery in a Mid-Atlantic regionalized setting. Future research should focus on the impact of regionalization on timely delivery of surgical care and other quality metrics. Copyright © 2015 Elsevier Inc. All rights reserved.
Caine, Lynda Z; Pinkham, Ashley M; Noble, James T
A quasiexperimental pre- and posttest design was used to evaluate hand hygiene (HH) rates on a medical-surgical unit. Data were collected by asking patients if they had seen or heard staff members cleaning their hands. Sixty-five percent of patients reported seeing or hearing staff perform HH preintervention and 93% reported observations postintervention (P awareness of personal HH behavior. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
The prevalence of diabetes is on the increase in developed countries. Accordingly, the prevention and treatment of vision-threatening diabetic eye complications is assuming greater importance. The overall aim of this thesis is to analyse risk factors for intraocular surgery in a large diabetes...... population and to report surgical results. The specific objectives are to (1) estimate the incidence of diabetic vitrectomy and analyse risk factors (Study I), (2) report long-term results, prognostic factors and incidence of cataract surgery after diabetic vitrectomy (Study II), (3) report results...... and prognostic factors after cataract surgery in diabetes patients (Study III) and (4) analyse risk factors for diabetic papillopathy with emphasis on metabolic control variability (Study IV). All studies are based on a close-to-complete national surgery register and a large, closely followed diabetic...
Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda
Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.
Boutry, Nathalie; Lardé, Anne; Lapègue, Franck; Solau-Gervais, Elizabeth; Flipo, René-Marc; Cotten, Anne
To describe the magnetic resonance (MRI) imaging findings of the feet in patients with early rheumatoid arthritis (RA), and to compare MRI appearance of the feet with that of the hands. Thirty consecutive patients (18 women, 12 men; age range 19-64 yrs) with early RA underwent MRI of hands and feet. Axial fat suppressed gadolinium enhanced T1 weighted spin-echo and gadolinium enhanced 3-dimensional gradient-echo (FLASH) images were obtained. In the hands, MRI findings suggested active synovitis of the wrist and metacarpophalangeal (MCP) joints in 28 (93%) and 27 (90%) patients, respectively. In the feet, active synovitis was observed in 29 (97%) patients. Bone erosions were seen in the wrist joints in 24 (80%) patients. Observers found as many bony changes in the MCP as in the metatarsophalangeal joints [23 (77%) patients]. MRI detected tenosynovitis in 16 (53%) patients in the hands, and in 18 (60%) patients in the feet. Bursitis located between or beneath the metatarsal heads was a common MRI finding [19 (63%) patients]. Additional MRI of the feet may be useful when evaluation of the hands does not help identify early RA.
Sahin, Fusun; Akkaya, Nuray; Kuran, Banu; Dogu, Beril; Simsir Atalay, Nilgun; Oguzhanoglu, Nalan
Objective: The aim of this study was to compare patients who were injured by punching glass with patients who were injured accidentally, according to demographical, clinical, and psychological parameters.Methods: The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory (BPI), and t...
Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115
I. L. Chernikovskiy
Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of
Salehahmadi, Zeinab; Rafie, Seyyed Reza
Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery.
Sousa, Cristina Silva; Turrini, Ruth Natalia Teresa
Purpose: To create and validate educational material for patients undergoing orthognathic surgery. Methods: The design included five phases: (a) a review of the literature regarding surgical complications; (b) gathering information on the needs of patients through blogs and virtual communities; (c) evaluating patient perceptions of the post-operative period through a focus group; (d) obtaining information through specialists using the Delphi technique and validation by judges; and (e) vali...
Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R
Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771
Kim, Eun Hyuk; Jang, Min Cheol; Seo, Jeong Pyo; Jang, Sung Ho; Song, Jun Chan; Jo, Hae Min
Objective To describe a hand-stretching device that was developed for the management of hand spasticity in chronic hemiparetic stroke patients, and the effects of this device on hand spasticity. Methods Fifteen chronic hemiparetic stroke patients with finger flexor spasticity were recruited and randomly assigned to an intervention group (8 patients) or a control group (7 patients). The stretching device consists of a resting hand splint, a finger and thumb stretcher, and a frame. In use, the ...
(16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted...... of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients...
Full Text Available Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05, after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.
Puvanesarajah, Varun; Jain, Amit; Qureshi, Rabia; Carstensen, S Evan; Tyger, Rosemarie; Hassanzadeh, Hamid
Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates. The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes. Copyright Â© 2016. Published by Elsevier Inc.
Engelbert, Travis L; Fernandes-Taylor, Sara; Gupta, Prateek K; Kent, K Craig; Matsumura, Jon
Readmission after a vascular surgery intervention is frequent, costly, and often considered preventable. Vascular surgery outcomes have recently been scrutinized by Medicare because of the high rates of readmission. We determined patient and clinical characteristics associated with readmission in a cohort of vascular surgery patients. From 2009 to 2013, the medical records of all patients (n = 2505) undergoing interventions by the vascular surgery service at a single tertiary care institution were retrospectively reviewed. Sociodemographic and clinical characteristics were examined for association with 30-day readmission to the same institution. The 30-day readmission rate to the same institution was 9.7 % (n = 244). Procedures most likely to result in readmission were below-knee (25%), foot (22%), and toe amputations (19%), as well as lower extremity revascularization (22%). Patients covered by Medicaid (16.8%) and Medicare (10.0%) were most likely to be readmitted, followed by fee-for-service (9.5%), self-pay (8.0%), and health maintenance organizations (5.5%; P vs 6.2% low severity; P vs 6.1 days, respectively; P vs 9.5% without intensive care unit stay; P institutions must identify high-risk patients. Efforts should focus on subgroups undergoing selected interventions (amputations, lower extremity revascularization), those with urgent admissions, and patients with extended hospital stays. Patients in need of postacute care upon discharge are especially prone to readmission, requiring special attention to discharge planning and coordination of postdischarge care. By focusing on subgroups at risk for readmission, preventative resources can be efficiently targeted. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Vijayalakshmi, S; Ramkumar, S; Narayan, K A; Vaithiyanathan, P
Each year, millions of patients around the world are affected by Health Care Associated Infections (HCAIs). Understanding and assessing the global burden of HCAI is one of the key areas of work to improve the hand hygiene. To assess the patient empowerment and awareness on hand hygiene among online users. A web-based cross-sectional survey was conducted during September 2013 to December 2013 among adults. A predesigned questionnaire to assess the awareness on hand hygiene was sent to volunteers through emails and social networking sites. The data were transferred to excel sheet and analyzed in Epi info and represented in proportions and percentages. Total 94 (57%) participants responded to the survey among which 51.1% were males and 48.9% were females. Majority of them belongs to the age group of 20 to 35 years. Only 28.7% of them said they will ever ask health care worker to wash their hands before they examine. A 27.7% of the participants reported that their country/community have a program that educates/communicates with patients about the importance of hand hygiene. Adherence and compliance to hand hygiene practices is suboptimal among people. There seems to be a lack of knowledge regarding hand hygiene.
Vargel, S; Uluşahin, A
The purpose of this study was to investigate the presence of psychiatric symptoms and evaluate the perceptive, cognitive, and behavioral aspects of body image in cosmetic surgery patients. These parameters of 20 cosmetic patients and of 20 control patients matched for age, gender, education, and marital status who attended the general surgery department for minor surgery were compared in a cross-sectional design. Symptom Check List-90 (SCL-90), Beck Depression Inventory (BDI), and The Multi-Dimensional Body Self Relations Questionnaire were administered to both groups. No significant difference was determined in the rates of psychopathology of the patient and control groups. Scales assessing self-image did not indicate any significant difference between the groups. Four (20%) of the cosmetic patients, however, were diagnosed with body dysmorphic disorder according to DSM-IV. Cosmetic patients were usually defensive towards psychological evaluations. A wide range of diversity was determined in the psychiatric evaluation of the cosmetic patient group. While some patients exhibited healthy psychological traits, some had severe depressive disorder or nearly psychotic somatic preoccupations.
Palamar, D; Er, G; Terlemez, R; Ustun, I; Can, G; Saridogan, M
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the hand joints and leading to impairment in hand functions. Evaluation of functional impairment is necessary for assessing patient's quality of life, disease activity, and treatment outcome. To date, many scientific studies assessed the disease activity of patients with RA, but little attention has been carried out to assess these patients' hand functions and dexterity. The purposes of this study were to determine the clinical relevance of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), hand dexterity with the Purdue Pegboard Test (PPT), and handgrip strength and pinch strengths of RA patients and to look into their relation between each other. A prospective trial was performed in women with RA who were followed at the physical medicine and rehabilitation department of our university hospital. Eighty-two women between the ages of 18 and 70, with a diagnosis of RA according to the 2010 American College of Rheumatology/the European League Against Rheumatism (ACR/EULAR) criterion, were recruited to the study. The Disease Activity Scores were determined by using Disease Activity Score-28 (DAS-28). Handgrip strength was measured with a Jamar dynamometer, and lateral, palmar, and tip pinch strengths were measured by a pinchmeter. Hand functions were evaluated with the PPT, and functional outcomes were assessed with the QuickDASH questionnaire. The mean age of the study group was 49.27 ± 10.69 years. The average values of DAS-28 and the QuickDASH values were found to be 4.22 ± 1.28 and 38.33 ± 19.78, consecutively. High correlation was observed between DAS-28 and the QuickDASH values (p hands were significantly correlated with the QuickDASH values (p hand (p hand (p hands were correlated statistically significantly with DAS-28 and the QuickDASH scores (p hands were correlated with DAS-28 scores, but correlation with the QuickDASH scores was seen just in the dominant
Full Text Available Aims and Objectives: We evaluated the factors which affect patient satisfaction and their expectations toward “surgery first” and conventional orthognathic surgery. Materials and Methods: Questionnaires consisting of 17 questions were given to the subjects postoperatively who had undergone Le fort 1 maxillary superior impaction for skeletal gummy smile correction with conventional orthognathic surgery and “surgery first” approach. Eleven-point rating scale based on a (visual analog scale; 0 = poor; 10 = excellent were used to answer six questions. Ten closed-form questions were also included as well as one open question for “further remarks.” Results: Nineteen patients (12 females, 07 males; mean age, 23.4 ± 4.9 [standard deviation] years gave their consent to participate in the study. The intention to undergo surgery only for esthetics was noted in 42.11% of patients; only improvement of chewing function in 21.05% and both in 36.84%. Conclusion: The most common factor for patient satisfaction after “surgery first” and conventional orthognathic surgery was facial esthetics, but masticatory function and even psychological aspects should be considered equally when planning surgery. The patient satisfaction was more in “surgery first” than conventional orthognathic surgery. The timing of treatment and immediate results are important factors toward patient satisfaction.
Yuvaram N.V. Reddy
Full Text Available This is a prospective study evaluating hand grip strength as a nutritional marker in maintenance dialysis patients. Thirty CAPD and 50 MHD patients were assessed for hand grip strength (in the non-fistula arm and demographic variables. In the MHD, 60% diabetic and in PD 66.7% were diabetic. In the MHD patients, Mean Age - 53.62±12.45, 78% Males and 22% Females, Hb-9.7±1.1 g/dL and 3.86±2.83 years on dialysis and in PD patients, mean age - 58.6±11.52 , 63.3% males and 26.7% females, Hb – 10.5±1.4 g/dL and 3.33±2.6 mean years on dialysis. Hand Grip Strength was 11.58+3.7 kg pre-dialysis and 9.2+3.6 kg post dialysis in MHD and 10.8+2.9 kg in PD patients. We found that malnutrition was present in 90% of MHD (10% severe, 24% moderate, 56% mild and 100% (6.7% severe, 40% moderate, 53.3% mild of PD patients via hand grip comparison. In conclusion, hand grip strength is a simple tool to measure the muscle mass as a measure of malnutrition in dialysis patients.
... de la base del pulgar Dedo en gatillo Quistes sinoviales Síndrome del túnel carpiano Epicondilitis lateral (codo ... de la base del pulgar Dedo en gatillo Quistes sinoviales Síndrome del túnel carpiano Resources All Topics ...
Hoashi, Takaya; Hirahara, Norimichi; Murakami, Arata; Hirata, Yasutaka; Ichikawa, Hajime; Kobayashi, Junjiro; Takamoto, Shinichi
Current surgical outcomes of congenital heart surgery for patients with Down syndrome are unclear.Methods and Results:Of 29,087 operations between 2008 and 2012 registered in the Japan Congenital Cardiovascular Surgery Database (JCCVSD), 2,651 were carried out for patients with Down syndrome (9%). Of those, 5 major biventricular repair procedures [ventricular septal defect repair (n=752), atrioventricular septal defect repair (n=452), patent ductus arteriosus closure (n=184), atrial septal defect repair (n=167), tetralogy of Fallot (TOF) repair (n=108)], as well as 2 major single ventricular palliations [bidirectional Glenn (n=21) and Fontan operation (n=25)] were selected and their outcomes were compared. The 90-day and in-hospital mortality rates for all 5 major biventricular repair procedures and bidirectional Glenn were similarly low in patients with Down syndrome compared with patients without Down syndrome. On the other hand, mortality after Fontan operation in patients with Down syndrome was significantly higher than in patients without Down syndrome (42/1,558=2.7% vs. 3/25=12.0%, P=0.005). Although intensive management of pulmonary hypertension is essential, analysis of the JCCVSD revealed favorable early prognostic outcomes after 5 major biventricular procedures and bidirectional Glenn in patients with Down syndrome. Indication of the Fontan operation for patients with Down syndrome should be carefully decided.
Blanc, Pierre; Lointier, Patrice; Breton, Christophe; Debs, Tarek; Kassir, Radwan
Laparoscopic One Anastomosis Gastric Bypass (LOAGB) is one of the main bariatric procedures that require a safe and reproducible gastrojejunal anastomosis. Barbed suture has been widely used for surgery in recent years; however, few studies have reported their use for gastro-intestinal anastomosis. We proposed their use for totally hand-sewn anastomosis during LOAGB. The objective of this study is to evaluate the risk of leaks and stenosis after a hand-sewn anastomosis using an absorbable bidirectional monofilament barbed suture: Stratafix®. The study was done in a private practice setting. Between April and November 2014, 50 consecutive patients undergoing a hand-sewn antecolic, antegastric gastrojejunal anastomosis (GJA) using Stratafix®. Pre, intra, and postoperative parameters were assessed for these patients. No fistulas or anastomotic stenosis had occurred up to 6 months after surgery. All procedures were completed laparoscopically, and no intraoperative complications occurred. The mean length of hospital stay was 3 days. The use of an absorbable bidirectional monofilament barbed suture for the GJA was safe. Further prospective studies with a higher number of patients are needed to address the safety and efficacy of the absorbable bidirectional monofilament barbed suture in bariatric surgery.
Cataract surgery is a highly successful, high-volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost-effective, high-quality services that meet the needs of patients. This paper aims to describe 18-month results of a sustainable program to maximize the safety of cataract surgery training. Modifications to the comprehensive cataract-training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner. Prior to intervention, PCR rates for trainee-surgeons averaged 3.34 per cent cf international published figures of 4.6-10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p safety. After 18 months follow-up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p goals can be extrapolated to other surgical disciplines. This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.
Budd, Henry R; Larson, Debbie; Chojnowski, Adrian; Shepstone, Lee
Retrospective Cohort. There is currently no validated patient reported outcome measure (PROM) for Dupuytren's disease. We have performed a retrospective analysis of QuickDASH scores taken before and after surgery for Dupuytren's disease to assess the validity and responsiveness of the QuickDASH and evaluate its suitability to being a PROM for this condition. To determine the eligibility of the QuickDASH score as a Patient Reported Outcome Measure for Dupuytren's disease. Patients were identified from the hand therapy database that had surgery performed between January 2006 and April 2008 who had documented pre- and post-operative QuickDASH scores. 69 patients were identified with complete datasets with a mean change in QuickDASH score of -7.14 (p < 0.001) and an improvement of extension deficit by 68.1 degrees (p < 0.001) at a mean 110 day follow-up. The change in QuickDASH score did not correlate with the change in extension deficit. The effect size was 0.545 and the standardised response mean was 0.580. The QuickDASH is an acceptable PROM for Dupuytren's surgery with limitations. Further research is needed examining PROMs with this common condition. n/a. Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Renholm, Marja; Suominen, Tarja; Puukka, Pauli; Leino-Kilpi, Helena
The increase in day surgery has brought about a significant change in patient care and care continuity. The purpose of this study was to analyze nurses' perceptions of the realization of continuity of care in day surgery. Continuity of care is examined from the perspectives of time, flow, co-ordination flow, caring relationship flow, and information flow. Descriptive study. A questionnaire including demographics and questions about continuity of care was completed by 83 of the 120 eligible nurses (response rate, 69%) in one hospital district in Finland. According to the nurses, continuity of patient care is mostly well realized. On the day of surgery, information flow was the domain that was best realized. In the opinion of the nurses, continuity of care was least realized at home before surgery and at home during the period after surgery. Based on nurses' perceptions, continuity of care was relatively well realized. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Morales Bertrand, J; Rodríguez Sánchez, J M; Ruiz Guerrero, M F
To study the epidemiological characteristics and the results of strabismus surgery of high myopic patients under topical anaesthesia. Retrospective study of nine high myopic patients with restrictive myopic myopathy (RMM) that underwent surgery in the last year and with a minimum follow-up of at least 6 months following surgery. Clinical findings, alteration of the extrinsic ocular motility (EOM) and response to surgical treatment were evaluated in each case. RMM was more frequent in women, average age was 46 years and average refractive error was 14 diopters. Diplopia was the most frequent reason for consultation, followed by the wish to undergo surgery because of an aesthetically unacceptable strabismus. High myopia was the most frequent etiology. One case was secondary to decompensated fourth cranial nerve palsy. The alteration of the EOM more frequently observed was endotropia associated with hypotropia. The recurrence rate of the deviation was 44%, occurring generally in the immediate postoperative period. In these cases botulinum toxin is a valid treatment option. Topical anaesthesia offers undoubted advantages for a better adjustment of diplopia in RMM surgery. During the intraoperative adjustment it is convenient to overcorrect the horizontal deviation and to undercorrect the vertical deviation.
Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen
Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin
Crawford, Todd C; Carter, Michael V; Patel, Rina K; Suarez-Pierre, Alejandro; Lin, Sophie Z; Magruder, Jonathan Trent; Grimm, Joshua C; Cameron, Duke E; Baumgartner, William A; Mandal, Kaushik
Sickle cell disease is a life-limiting inherited hemoglobinopathy that poses inherent risk for surgical complications following cardiac operations. In this review, we discuss preoperative considerations, intraoperative decision-making, and postoperative strategies to optimize the care of a patient with sickle cell disease undergoing cardiac surgery. © 2017 Wiley Periodicals, Inc.
Mar 1, 2014 ... primary pterygium followed by conjunctival graft. Young patient's age determines pterygium recurrence after surgery. Anguria P1, Ntuli S2, Carmichael T1. 1. Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand Johannesburg, South. Africa. 2. Department of Community ...
Apical; lateral—costal; postero-basal and diaphragmatic breathing exercises. The elective ... Vital capacity and peak expiratory ﬂow rates were measured daily after each exercise training session. ... that breathing exercise training improved vital capacity and peak expiratory ﬂow rate of the abdominal surgery patients. It was.
Objective: To prospectively study the behaviour of oral surgery patients given verbal and written instructions, verbal instructions alone and written instructions alone after minor surgical procedures to return for review visits, remember correctly form of instruction given, compliance and level of satisfaction with treatment.
Thompson, P J; Baxendale, S A; McEvoy, A W; Duncan, J S
To examine the cognitive risks of temporal lobe surgery in patients aged 50 years and older. We analysed data from 55 patients who underwent temporal lobe surgery (26 left-sided:29 right sided) from 1988 to 2012 at our centre. Pre-surgical and one year post-operative memory and naming capacity were compared to data obtained from two younger cohorts; 185 aged 18-30 and 220 aged 31-49. Pre-operative memory impairments were most marked for the oldest cohort and were associated with a longer duration of epilepsy. Naming capacity improved with age and better performance was associated with a later age at epilepsy onset. Post-operative declines were largest in older patients, achieving statistical significance for verbal memory, naming and subjective ratings. Left temporal lobe resections carried the greatest risk of memory and naming decline. Cognitive outcomes were unrelated to seizure outcome, VIQ or mood. Our findings indicate the cognitive risks of TLE surgery are greater for older patients. Cognitive outcomes need to be considered when assessing the efficacy of epilepsy surgery in older cohorts and pre-operative performance levels need to be taken into account. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
The anaesthetic management of patients with acromegaly, a rare clinical syndrome, for urgent non pituitary surgery has little documentation in the literature. We report such a case further complicated by dilated cardiomyopathy. The anaethetic challenges in the face of limited resources are highlighted. Keywords: ...
Ozuna, J; Snyder, G
A chart review of the patients who received epidural morphine for lumbar surgery during the first year of implementation of the procedure was conducted. This article reviews the pharmacology and side effects of epidural morphine, describes the procedure of administering epidural morphine, discusses side effects and technical problems encountered, and presents implications for nursing practice.
Stephan, Jean-Marie; Goodheart, Michael J; McDonald, Megan; Hansen, Jean; Reyes, Henry D; Button, Anna; Bender, David
Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph
Koster, E S; Schmidt, A; Philbert, D; van de Garde, E M W; Bouvy, M L
Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery. Patients aged ≥18 years visiting the preoperative screening department were approached in the waiting area and invited to participate in a brief interview including the Functional Communicative Critical Health Literacy (FCCHL). In total, 225 patients (84.9% response) were studied. Based on the FCCHL, 37.3% of the patients were classified as having limited health literacy. The mean score in the critical domain (2.7 ± 0.9) was lower than scores in the functional (3.3 ± 0.6) and communicative (3.3 ± 0.6) domains. More than one third of the patients admitted to the hospital for surgery had limited health literacy. Healthcare professionals should be aware of the different health literacy levels and tailor their information provision strategies accordingly.
Spoor, A B; Öner, F C
Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated discs, adjacent disc disease, disc degeneration, failed back surgery syndrome or pseudoartrosis all have symptoms of LBP in different ways. Chronic low back pain patients are advised to stay active, however, there is no strong evidence that exercise therapy is significantly different than other nonsurgical therapies. Not every patient with symptoms of LBP is an appropriate candidate for surgery. Even with thorough systematic reviews, no proof can be found for the benefit of surgery in patients with low back pain, without serious neurologic deficit. And subjects like psychologic and socio-demographic factors also seem to be influencing a patients perception of back pain, expectations of treatment, and outcomes of treatment. Open lumbar fusion procedures are typically lengthy procedures and require a long exposure, which may result in ischemic necrosis of the paraspinal musculature, atrophy, and prolonged back pain. Minimally invasive spine surgery needed to take care of a decrease in muscle injuries due to retraction and avoidance of disruption of the osseotendineous complex of the paraspinal muscles, especially the multifidus attachment to the spinous process and superior articular process. Therefore, effort has been made to develop percutaneous fusion, as well as fixation methods, which avoid the negative effects of open surgery. Several minimally invasive fusion strategies have been described, like anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and two lateral approaches (XLIF and DLIF), all with pro's and con's compared to open surgery and each other. The effect of MIS of all type is
Beltran, N; Sanchez-Miranda, G; Godinez, M; Diaz, U; Sacristan, E
Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in the critically ill. The present study evaluates spectral differences in elective cardiovascular surgery patients compared with the impedance spectra of the gastric mucosa in healthy adults. An impedance spectroscopy probe and nasogastric tube (ISP/NGT) was placed into the stomach of 77 heart surgery and 21 healthy volunteers. The recorded impedance spectra were classified into 3 groups: group 1 for healthy volunteers; group 2 for patients with neither ischemia nor complications; and group 3 for patients with ischemia and complications during the first 3 days in the recovery unit. There were statistical differences in resistance (p<0.001) and reactance (p<0.001) among the 3 groups. The results show that impedance spectra are distinct and significantly different in patients with probable ischemic mucosal injury compared to healthy subjects, and therefore this technology may be a useful prognostic and diagnostic monitoring tool.
Rayegani, S M; Raeissadat, S A; Sedighipour, L; Rezazadeh, I Mohammad; Bahrami, M H; Eliaspour, D; Khosrawi, S
The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.
Hensler, Stefanie; Herren, Daniel B; Marks, Miriam
Opening packaged food is a complex daily activity carried out worldwide. Peelable packaging, as used for cheese or meat, causes real problems for many consumers, especially elderly people and those with hand disorders. Our aim was to investigate the possibility of producing meat packaging that is easier for patients with hand disorders to open. One hundred patients with hand osteoarthritis were asked to open a meat package currently available in supermarkets (Type A) and a modified, newly designed version (Type B), and rate their experiences with a consumer satisfaction index (CSI). The mean CSI of the Type B packs was 68.9%, compared with 41.9% for Type A (p food packages that afford greater consumer satisfaction. Such future packaging would benefit not only people with hand disorders but also the population as a whole. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Demian, Nagi M; Shum, Jonathan W; Kessel, Ivan L; Eid, Ahmed
Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications. Prevention and thorough preparation are vital before the start of chemotherapy and radiation therapy. Oral complications must be addressed immediately and, even with the best management, can cause delays and interruption in treatment, with serious consequences for the outcome and prognosis. Copyright © 2014 Elsevier Inc. All rights reserved.
Cristina Silva Sousa, MSc
Conclusion: Creating a booklet involves more than simply writing summarized ideas on a paper and handing it to the patient. One must understand the population, involve the relevant professionals, and obtain high-quality graphic aids for this type of educational material.
Half of patients with infectious endocarditis have surgery during the active phase of infective endocarditis (before the end of antibiotic therapy). The American Heart Association and the European Society of Cardiology, independently from each other, have published guidelines in September 2015. As regards surgical indications, these guidelines are similar. The surgical indication must be a common decision of a multidisciplinary team of experts in cardiology, cardiac surgery, imaging and infectious diseases. The main indications are heart failure, non-infectious process control and prevention of embolisms. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
In recent years, facial rejuvenation using Intense Pulsed Light (IPL) is in demand and there have been many reports. However, hand rejuvenation, which aims to treat lentigines on the dorsal hand and wrinkles, is in demand but with few reports. In this study, hand rejuvenation was attempted using two wavelengths of a standard IPL system. It focuses mainly on improvement of lentigines, and efficacy on wrinkles on the dorsal hand will be discussed as well. The subjects were 128 Japanese patients (average age 58.1) who had lentigines and wrinkles on the dorsa of both hands, and the wavelength spectra of 560 - 1200 nm and 515 - 1200 nm were applied. In general, the number of treatments was not fixed, and further treatments beyond the first treatment were added only when asked for by the patient. Lentigines were assessed on 4 levels and wrinkles on 3 levels. The results in lentigines were graded "Excellent" in 45.3%, "Good" in 14.8%, "Unchanged" in 37.5% and "Bad" in 2.3% of the patients. Dark-toned lentigines in particular improved after one treatment. On the other hand, the results in wrinkles were graded as "Effective" in 25.0%, "Hard to tell" in 39.1% and "Ineffective" in 35.9% of the patients after the first treatment, but there was increased improvement in some cases after multiple treatments. By using appropriate IPL parameters with specific cut-off filters, dark-toned and flat senile lentigines could be treated effectively with a small number of treatments. On the other hand, improvement of fine dorsal wrinkles was noticed but more finesse is needed as to how to apply IPL and to decide on the number of treatments. Further study is necessary, but overall it can be said that IPL is an effective choice for hand rejuvenation.
Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.
Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy
Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…
de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid
Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.
Martina eDe Zwaan
Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.
de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid
Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839
Oral rehydration therapy before surgery may be useful for elderly patients in perioperative management especially induction of general anesthesia, as they cannot preserve water in the body sufficiently. In elderly patients oral rehydration therapy is favorable to intravenous hydration as in younger patients. However, if swallowing is impaired or there are risks for aspiration, gastric emptying rate is decreased; gastroesophageal reflux disease is pointed out; cognitive function is disordered; or delirium has appeared, oral rehydration therapy should be carefully considered. It may be necessary to provide preoperative oral rehydration therapy to high risk elderly patients when they are hospitalized and they should be watched for taking oral rehydration solution soon by hospital nurses.
Carr, Tracey; Teucher, Ulrich; Casson, Alan G
The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.
Kaluinaitė, Greta; Mačiukaitienė, Jomantė; Jakubauskaitė, Ramunė
Introduction: Fast-track cardiac surgery today is an established and safe method because of achieved early tracheal extubation that leads to decreased length of hospital stay (LOS) with no increased risk of complications. However, we hypothesized, that fast-track protocols not only improve such system-oriented outcomes as LOS or complication rate, but facilitate better patient-oriented outcomes such as functional recovery. Our fast-track protocol was based on ERAS society guidelines, which be...
Hughes, Michael; Coolsen, Marielle M E; Aahlin, Eirik K; Harrison, Ewen M; McNally, Stephen J; Dejong, C H C; Lassen, Kristoffer; Wigmore, Stephen J
Enhanced recovery after surgery (ERAS) is a well-established pathway of perioperative care in surgery in an increasing number of specialties. To implement protocols and maintain high levels of compliance, continued support from care providers and patients is vital. This survey aimed to assess the perceptions of care providers and patients of the relevance and importance of the ERAS targets and strategies. Pre- and post-operative surveys were completed by patients who underwent major hepatic, colorectal, or oesophagogastric surgery in three major centers in Scotland, Norway, and The Netherlands. Anonymous web-based and article surveys were also sent to surgeons, anesthetists, and nurses experienced in delivering enhanced recovery protocols. Each questionnaire asked the responder to rate a selection of enhanced recovery targets and strategies in terms of perceived importance. One hundred nine patients and 57 care providers completed the preoperative survey. Overall, both patients and care providers rated the majority of items as important and supported ERAS principles. Freedom from nausea (median, 10; interquartile range [IQR], 8-10) and pain at rest (median, 10; IQR, 8-10) were the care components rated the highest by both patients and care providers. Early return of bowel function (median, 7; IQR, 5-8) and avoiding preanesthetic sedation (median, 6; IQR, 3.75-8) were scored the lowest by care providers. ERAS principles are supported by both patients and care providers. This is important when attempting to implement and maintain an ERAS program. Controversies still remain regarding the relative importance of individual ERAS components. Copyright © 2015 Elsevier Inc. All rights reserved.
Dirven, R.; Kooijman, P.G.C.; Wouters, Y.; Marres, H.A.M.
OBJECTIVES/HYPOTHESIS: Time of adherence of adhesive baseplate housings to the neck of a laryngectomized patient is one of the main problems that account for the low number of laryngectomy patients who benefit from hands-free speech. An external neck brace (ENB 1.0) was introduced to support
SCHIPPER, A; LUBBERS, WJ; HOGEWEG, M; DESOLDENHOFF, R
The objective of the study was to determine the magnitude of hand/feet/eye disabilities in newly diagnosed leprosy patients by examining all newly diagnosed leprosy patients who presented at the Eastern Leprosy Control Project (supported by The Netherlands Leprosy Relief Association), made up of a
Yonan, Yousif; Ochoa, Shari
There have been several investigations into possible health risks of surgical smoke exposure, and it has previously been associated with harboring pathogens and carcinogens. Patients in the authors' practice have expressed that the odor from the smoke created by electrosurgical equipment is unpleasant. The authors sought to determine if smoke evacuation decreases patient perception of smoke created by electrosurgery during Mohs surgery and if it subsequently improves patient satisfaction with their surgical experience by minimizing the associated odor. Thirty patients were enrolled in this comparative trial. Smoke evacuation was used during closure but not during Mohs stages. Patients were queried regarding their experience and preferences during and at the end of the procedure. 100% of patients reported the perception of a burning odor during removal of Mohs stages, compared with 40% reporting the perception of a burning odor during closure. During the Mohs stages, 66.6% of patients reported the odor as unpleasant compared with 16.6% of patients during closure. There were no statistically significant differences in patient perceptions when stratified by age, sex, or surgical site. The authors believe that using a wall suction smoke evacuation system is simple and can result in a more pleasant experience for patients undergoing Mohs surgery.
Gilmartin, Jo; Wright, Kerrie
The rapid expansion in day surgery has facilitated a shift in surgical nursing intervention. The evolving evidence base has a major part to play in influencing nurse-led preassessment, information provision, pain management and postoperative intervention. However, the literature is characterised by a number of deficits: poor attention to patient experience from admission to discharge, anxieties evoked and the potential needs of patients are not well articulated. The purpose of this paper is to describe and interpret patients' experiences of contemporary day surgery. This hermeneutic phenomenological approach focused on the experience of 20 adult patients. Data was collected by using unstructured interviews. The transcripts were interpreted through the identification of four prevalent themes using the phenomenological method. The themes that emerged from the data are emphasised, ranging from the feeling of empowerment during preparation, through apprehensions encountered and the feeling of abandonment in the preoperative waiting area, to recovery dynamics. The study demonstrates that the majority of the patients felt abandoned in the preoperative stage and nurses did not recognise the importance of ongoing psychological support. Therefore, it is crucial to strengthen the provision of emotional support and person-centred care in a day surgery context. There is also a need to be aware that environmental factors can impact on patient anxiety, promoting the use of music preoperatively can reduce anxiety and increase well-being. Crucially health professionals need to facilitate person-centred and continuity of care throughout the day surgery experience. Using dynamic interpersonal skills, such as active listening 'holding''containment' and attunement to reduce anxiety and feelings of abandonment in the preoperative period. Moreover, being alert to verbal utterances, para-language and non-verbal cues demonstrated by the patient. Specific information about delays regarding
McIntosh, Rachel; Webb, Hannah; Hartley, Matthew; Brooks, Marcus
The Tracey Report has recently raised the status of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) orders in the hospital setting. Guidelines are in place both nationally and locally to provide advice to clinicians on when to discuss DNACPR, and the approach to be taken. There was concern that on a busy regional vascular surgery unit, discussion of resuscitation status was not regular practice. Consequently, some patients were at risk of being inappropriately resuscitated, particularly out of hours. The North Bristol Somerset and Gloucester DNAR decision tree was the tool used to decide whether a patient should have a documented discussion and/or a DNACPR form completed. We correlated the outcome of the decision tree with the presence of a DNACPR form or documented resuscitation discussion. Baseline measurements from all vascular inpatients on the vascular surgery unit demonstrated that only 27% had a DNACPR form or documented discussion in concordance with the DNACPR Decision Tree outcome. The aim of this project was to increase the proportion of patients with concordance of the DNACPR decision tree outcome with documented discussion or DNACPR form. The following three simple interventions raised concordance from 27% to 64% of patients on the vascular surgery unit. 1. Including resuscitation status of each patient as a column in the doctors daily handover. 2. Posters in staff only areas to highlight the meaning of DNACPR and raise awareness of the DNACPR decision tree. 3. Educational meeting surrounding DNACPR with the vascular surgery consultants, led by a care of the elderly consultant . This project has highlighted how raising awareness around DNACPR increases discussion amongst the clinical team surrounding resuscitation status of a patient. Consequently, this enables discussion to be had with patient and their family.
Altschul, David; Kobets, Andrew; Nakhla, Jonathan; Jada, Ajit; Nasser, Rani; Kinon, Merritt D; Yassari, Reza; Houten, John
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular
Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena
A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.
Full Text Available Objectives: The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA due to deformities, which occur in approximately 90% of patients. It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb. The study aimed to assess the effect of rehabilitation on the function of the hand in rheumatoid arthritis. Material and methods: The study group consisted of 40 women with RA. The patients had been previously treated at the Rehabilitation Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The study group underwent 3 weeks of rehabilitation involving individual therapy, exercises with equipment, patient education and physical therapy. The control group included women without a diagnosis of RA, hands pain-free and fully mobile. In both groups the hand was assessed for grip value, grip quality and manipulative ability. In the study group the basis of pain intensity was noted. The measurements were performed twice – prior to the rehabilitation and after 3 weeks of rehabilitation in women with RA and once in women without hand problems. Results : The results obtained revealed marked limitation of hand function in patients with rheumatoid arthritis. The treatment resulted in an improvement of all assessed parameters except cylindrical grip, in which only a part of the findings was statistically significant. Conclusions : The analysis of the study material showed that appropriately adjusted and conducted hand physiotherapy in women with rheumatoid arthritis contributed to the improvement of its function by pain reduction, improved value and quality of grip, and also increased manipulative ability.
Księżopolska-Orłowska, Krystyna; Sadura-Sieklucka, Teresa; Kasprzak, Katarzyna; Gaszewska, Ewa; Rodkiewicz-Bogusławska, Agnieszka; Sokołowska, Beata
The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA) due to deformities, which occur in approximately 90% of patients. It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb. The study aimed to assess the effect of rehabilitation on the function of the hand in rheumatoid arthritis. The study group consisted of 40 women with RA. The patients had been previously treated at the Rehabilitation Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The study group underwent 3 weeks of rehabilitation involving individual therapy, exercises with equipment, patient education and physical therapy. The control group included women without a diagnosis of RA, hands pain-free and fully mobile. In both groups the hand was assessed for grip value, grip quality and manipulative ability. In the study group the basis of pain intensity was noted. The measurements were performed twice - prior to the rehabilitation and after 3 weeks of rehabilitation in women with RA and once in women without hand problems. The results obtained revealed marked limitation of hand function in patients with rheumatoid arthritis. The treatment resulted in an improvement of all assessed parameters except cylindrical grip, in which only a part of the findings was statistically significant. The analysis of the study material showed that appropriately adjusted and conducted hand physiotherapy in women with rheumatoid arthritis contributed to the improvement of its function by pain reduction, improved value and quality of grip, and also increased manipulative ability.
Ostrowska, Lucyna; Lech, Medard; Stefańska, Ewa; Jastrzębska-Mierzyńska, Marta; Smarkusz, Joanna
Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.
Machnica, Karolina; Pannain, Silvana; Schulwolf, Elizabeth; Bartfield, Jessica; Emanuele, Mary Ann
Bariatric surgery is a recommended treatment for diabetes in severely obese patients. Their immediate post-operative anti-hyperglycemic requirements differ from other hospitalized diabetics, yet no standardized protocols addressing glycemic control for this group exist. We aimed to create a safe, easily implemented protocol for immediate post-operative glycemic control, which we defined as the first 30 days. The protocol was designed by an interdisciplinary workgroup using review of available literature, approved institutional glycemic guidelines, and team members' experience with caring for bariatric surgery patients. Patients are offered post-discharge recommendations using the inpatient glycemic protocol. We designed a protocol with low risk of hypoglycemia that addresses the unique glycemic needs of diabetic bariatric population in the immediate post-operative period.
Zheng, Jun; Li, Hao; Zhao, He-Xiang; Guo, Rui; Lin, Sen; Dong, Wei; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao
Abstract Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0
Block, Andrew R
It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities. PMID:27417599
Andrew R Block
Full Text Available It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM, an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities.
Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Kamiya, Toru; Sato, Yumiko; Iuchi, Ritsuko; Tokuda, Yasuharu
Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%). Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. A total of 3 to 4 inpatient wards in 3 Japanese hospitals. Pre-post intervention study. The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates. We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary. © 2015 Society of Hospital Medicine.
Liu, Y Z; Ye, Z H; Yang, W L; Zhu, J X; Lu, Q J; Su, W L
Objective: To investigate the clinical value of ultrasound examination of carpal canal structure in patients with mild hand-arm vibration disease. Methods: A total of 29 patients (58 wrists) with mild hand-arm vibration disease who were treated in Shenzhen Prevention and Treatment Center for Occupational Diseases from May to December, 2015 were enrolled as observation group, and 20 healthy volunteers (40 wrists) were enrolled as the control group. Color Doppler ultrasound was used to observe the morphology and echo of the median nerve in the carpal canal and 9 muscle tendons and transverse carpal ligament. The thickness of transverse carpal ligament and diameter of the median nerve at the level of the hamulus of hamate bone were measured, as well as the cross-sectional area of the median nerve at the level of pisiform bone. Results: In the 29 patients with hand-arm vibration disease patients in the observation group, 8 experienced entrapment of the median nerve in the carpal canal, among whom 5 had entrapment in both wrists; there were 13 wrists (23%) with nerve entrapment and 45 wrists (77%) without nerve entrapment. Compared with the control group, the patients with hand-arm vibration disease and nerve entrapment in the observation group showed significant thickening of the transverse carpal ligament at the level of the hamulus of hamate bone and a significant increase in the cross-sectional area of the median nerve at the level of pisiform bone (Pligament at the level of the hamulus of hamate bone and the cross-sectional area of the median nerve at the level of pisiform bone (t=-9.397 and -4.385, both P>0.05) . Conclusion: Ultrasound examination can clearly show the radiological changes of carpal canal contents in patients with mild hand-arm vibration disease and has a certain diagnostic value in nerve damage in patients with hand-arm vibration disease.
Beltran, N E; Sanchez-Miranda, G; Godinez, M; Diaz, U; Sacristan, E
Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in critically ill patients. The present study characterizes human gastric impedance spectral changes under gastric hypoperfusion in patients undergoing cardiovascular surgery, and evaluates spectral differences between patients with no evidence of gastric ischemia and complications, and patients who developed ischemia and complications. Cole and Kun parameters were calculated over time to characterize changes as tissue injury progresses. Gastric ischemia was determined by air tonometry. Impedance spectroscopy spectra were obtained from 63 cardiovascular surgery patients. The recorded spectra were classified into three groups: group 1 for patients without ischemia or complications, group 2 for patients with a short period of ischemia (less than 2 h) and group 3 for patients with more than 4 h of gastric ischemia and complications. Two distinct dispersion regions of the spectra centered at about 316 Hz and 215 kHz become clearer as tissue damage develops. The average spectrum in group 3 shows a significant difference in tissue impedance at all frequencies relative to group 1. The parameters obtained for human gastric tissue show significant changes that occur at different times and at different frequencies as ischemia progresses, and could be correlated with patient outcome. This confirms our hypothesis that hypoperfusion and ischemia cause evident changes in the impedance spectra of the gastric wall. Therefore, this technology may be a useful prognostic and diagnostic monitoring tool.
Full Text Available Mikel Mikhail1, Keyvan Koushan2, Rajeshvar K Sharda2, Gloria Isaza2, Keith D Mann21Michael G DeGroote School of Medicine, 2Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, ON, CanadaPurpose: To report a case of aniridia in a pseudophakic patient following blunt trauma to the eye.Case report: The traumatized eye had cataract surgery through a 3.0 mm clear corneal incision 6 years prior to the incident. While there have been previous cases of traumatic aniridia in pseudophakic eyes, previous reports have all occurred closer to the time of the cataract surgery. We believe that the most likely mechanism of loss of iris tissue is through wound dehiscence, which would suggest the relative instability of clear corneal incisions several years postoperatively. The patient's visual acuity returned to 20/20 4 weeks post-trauma, with symptoms of glare which were managed by the use of a colored contact lens.Conclusion: The possibility of wound dehiscence should be recognized as an important clinical entity in the immediate postoperative period, but also several years following cataract surgery.Keywords: anirida, pseudophakia, cataract extraction, cataract, phacoemulsification, trauma
Bank, Jonathan; Fuller, Sam M; Henry, Ginard I; Zachary, Lawrence S
Raynaud phenomenon causes progressively decreasing blood flow to the extremities, resulting from an imbalance between vasoconstriction and vasodilation. Treatment options include biofeedback, phosphodiesterase inhibitors, calcium channel inhibitors, botulinum toxin injection, or surgical sympathectomy. The authors propose fat grafting to the hands as a method to delay progression of the disease. Indications included symptomatic Raynaud phenomenon with failure of previous management. Fat is harvested from abdominal depots. Approximately 30 ml of decanted fat is injected by means of blunt cannulae: 10 to 15 ml in the dorsum of the hand, 2 to 3 ml in the snuffbox, 1 to 2 ml in each dorsal webspace, 3 to 4 ml along the superficial palmar arch, 1 to 2 ml in volar webspaces 2 to 4, and 2 to 3 ml in the first webspace. Patients underwent preoperative and postoperative laser speckle imaging study to assess changes in perfusion. A total of 13 patients were treated (21 hands). Twelve patients had undergone prior botulinum toxin injection, and 11 patients had prior sympathectomies. Findings included reduced pain (average reduction, 6.86 of 10 to 2.38 of 10), fewer cold attacks, improved skin and soft-tissue texture, decrease in ulcerations, and patient-reported improved function. Three patients had no changes. Increased blood flow per imaging was noted in five of 11 hands tested. Six patients had decreased readings on laser imaging. None of the laser speckle imaging changes were statistically significant, and they did not correlate clinically. There were no major complications. Preliminary results of fat grafting to the hands of patients with Raynaud phenomenon revealed improved symptomatology with evidence suggestive of measurably increased perfusion in some cases. Fat grafting may benefit the management of this patient population. Therapeutic, IV.
Vidot, Denise C; Prado, Guillermo; De La Cruz-Munoz, Nestor; Spadola, Christine; Cuesta, Melissa; Messiah, Sarah E
Current literature is scarce in documenting marijuana use after bariatric weight loss surgery (WLS). The objective of this study was to explore the association among marijuana use patterns, disordered eating, and food addiction behaviors in patients 2 years after WLS. A university hospital in the United States. Participants (N = 50, mean age 28 y, standard deviation = 5.8) were administered a structured assessment that included the Addiction Severity Index, Yale Food Addiction Scale, Eating Disorder Examination Questionnaire, and Disordered Eating Questionnaire. Marijuana use was defined based on the Addiction Severity Index as current use (within 30 d), recent use (use in last year), and increased use (increased use since surgery). Data were analyzed using Fisher's exact tests and linear regression methods adjusting for age, gender, race/ethnicity, time since surgery, and change in body mass index. The majority of the sample was female (76%) and underwent Roux-en-Y gastric bypass (62%). Eighteen percent (18%) of the sample reported current marijuana use; 38% reported recent use; and 21.4% reported increased use post-WLS. A loss of controlled food intake was associated with current (P = .02) and increased post-WLS use (P = .01). Increased use and/or regular marijuana use predicted higher scores on eating disorder subscales compared with respective counterparts (P<.05). Current use did not significantly predict higher scores on the Yale Food Addiction Scale. Findings indicated marijuana use in post-WLS patients despite recommendations against use. A subgroup of WLS patients may be at risk for disordered eating post-WLS, particularly those who used marijuana before surgery, and should be closely monitored for several years post-WLS. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Aszmann, Oskar C; Roche, Aidan D; Salminger, Stefan; Paternostro-Sluga, Tatjana; Herceg, Malvina; Sturma, Agnes; Hofer, Christian; Farina, Dario
Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE. Copyright © 2015 Elsevier Ltd. All rights reserved.
Daisy Zanchi de Abreu Botene
Full Text Available This paper is a qualitative descriptive study, which aims to analyze how the academic education concerning hand hygiene contributes to the pediatric patient safety. This research was developed in an university hospital in Southern Brazil, in the pediatric unit, during the period of August to December, 2012. Sixteen healthcare professionals participated (doctors, nurses and physical therapists. A semi-structured interview was used to gather information. Data was organized by the software QSR Nvivo and analyzed using the content analysis technique. The results allowed us to list two thematic categories: "Hand hygiene and healthcare professionals' academic education"; and "Hand hygiene and professional life". The first thematic category will be presented in this paper. It was identified that the academic education contributes in an ineffective way to the creation of a patient safety culture. According to the professionals, there are gaps during the educational process regarding hand hygiene. The topic is treated in an ineffective and not very significant way to the learning and adhesion of hand hygiene in the professional life. It is recommended that, for the internalization of the practice by future professionals, a transversal, continuous and systematical approach is adopted during the professional's training, evaluations concerning the hand hygiene are done throughout the academic life as well as healthcare professors bethink the topic.
Hatemi, Ali Can; Güleç, Cağrı; Cine, Naci; Vural, Burçak; Hatırnaz, Ozden; Sayitoğlu, Müge; Oztunç, Funda; Saltık, Levent; Kansız, Erhan; Erginel Ünaltuna, Nihan
Atrial isomerism is a congenital disorder, which is characterized by lateralization defects in normally asymmetrical developing organs like the heart. Atrial isomerism is supposed to be caused by molecular defects during early development. The NKX2-5 is a cardiac specific transcription factor, which initiates and regulates downstream transcriptional cascades of cardiogenesis. The HAND1 is another transcription factor expressed in the heart, and it is characterized by an asymmetrical pattern of expression. In this study, we aimed to test whether mutations in NKX2-5 and HAND1 genes play a role in the etiology of atrial isomerism. This case-control study consisted of 70 patients who underwent surgical treatment for congenital heart defects including atrial isomerism, 80 healthy subjects (HAND1 gene) and 40 healthy subjects (NKX2-5 gene). All exons and exon-intron boundaries of NKX2-5 and HAND1 genes were analyzed by SSCP, and suspected samples were sequenced for mutation analysis. Digestion with appropriate restriction enzymes was performed for analysis of known mutations and polymorphisms. The frequencies of the alleles and the genotypes were compared among patient and control groups using the Chi-square and the Fisher tests when appropriate. In intronic region of HAND1 gene, we identified a C>G substitution both in patients and controls. Frequency of mutant allele (11, 42%) was found higher (p=0.046) in patient group than that of the control group (2.5%). Association between atrial isomerism and genotypes with mutant allele was found borderline significant (p=0.054). In NKX2-5 gene, we identified heterozygous Q170X (Gln170ter) mutation in one patient. We did not found any correlation between defined sequence variations and clinical properties of the patients. Our results suggest that mutations or sequence variations in HAND1 or NKX2-5 genes may play role in etiology or pathogenesis of atrial isomerism.
Kharrat, K; Assante, M; Chossegros, C; Cheynet, F; Blanc, J L; Guyot, L; Richard, O
Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact. We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded. We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved. This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.
Hurwitz, Dennis J; Ayeni, Omodele
Plastic surgeons subspecializing in body contouring are meeting the challenge of postbariatric surgery massive weight loss patients. With an appreciation of the magnitude of the surface deformity, and altered metabolism, nutrition, and psychological makeup of these patients, innovative plastic surgeons have forged an organized approach to preparation, operative technique, and postoperative care. Patients at greatest risk for complications are identified, appraised, and either their condition improved or they are counselled to reduce expectations. Beyond the removal of excess skin and adipose tissue, advanced gender-specific techniques have improved aesthetics. Copyright © 2016 Elsevier Inc. All rights reserved.
Kannan Megalingam, Rajesh; Apuroop, K. G. S.; Boddupalli, Sricharan
Many stroke and spinal cord injury patients suffer from paralysis which range from severe to nominal. Some of them, after therapy, could regain most of the motor control, particularly in hands if the severity level is not so high. In this paper we propose a hand orthosis for such patients whose stroke and spinal cord injury severity is nominal and the motor control in hands can be regained by therapy as part of their rehabilitation process. The patients can wear this orthosis and the therapy can be done with simple Human Computer Interface. The physicians, the physiotherapists and the patients themselves can carry out the therapy with the help of this device. The tests conducted in the lab and the results obtained are very promising that this can be an effective mechanism for stroke and spinal cord injury patients in their rehabilitation process. The hand orthosis is designed and fabricated locally so that it can be made available to such patients at an affordable cost.
Small animal oncologic surgery is a relatively new and rapidly expanding field of veterinary science. Many exciting and innovative techniques for surgical resection of invasive tumors have been developed and published in the last decade. Paralleling these developments have been major advancements in the frontiers of reconstructive options to close the defects after major ablative surgery. A more thorough understanding of the biologic behavior of tumors in our patients has permitted us to rationally approach selected patients with high doses of surgery with curative intent, palliation, or as part of a multimodality treatment plan. Invasive oncologic procedures require thorough preoperative planning and staging to accomplish the goal of tumor-free margins. Patient factors, specifically tumor type, grade, anatomic location, and extent of local invasion, will subsequently dictate the appropriate resection and reconstructive options available. Resection of the tumor with a wide margin of normal tissue is the surgeon's primary objective. The reconstructive phase of the surgery endeavors to restore functional and cosmetic integrity to the regional anatomy. Each resection and reconstruction procedure must be customized for the patient's disease. Thoughtful preoperative planning, timing, and intraoperative flexibility to unforeseen circumstances will minimize complications. Armed with a number of reconstructive options for each case, the surgeon develops intraoperative flexibility and latitude to be more aggressive during the primary resection. If the surgeon self-imposes limitations on the aggressive removal of the primary tumor by virtue of tissue closure concerns, the completeness of resection and patient survival may well be jeopardized. As familiarity and experience with different reconstructive options increases, the surgeon will have greater confidence in removing large volumes of diseased tissue.
Full Text Available Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc., the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications
Engstrand, Christina; Krevers, Barbro; Nylander, Göran; Kvist, Joanna
PURPOSE: To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. METHODS: This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contract...
Yuan, Xiang; Martin Hawver, Lisa R; Ojo, Peter; Wolfe, Luke M; Meador, Jill G; Kellum, John M; Maher, James W
Recent reports have documented greater mortality for bariatric surgery in Medicare (MC) patients compared with patients from other payors. We reviewed our database for the mortality and outcomes of 282 MC and 3169 non-Medicare (NMC) patients undergoing bariatric surgery. Of the MC patients, 27 were >65 years of age, and 255 were receiving disability. The average age was 48.45 +/- 11.8 years, and the average BMI was 52.4 +/- 10.0 kg/m2. NMC patients had average age of 40.0 +/- 10.1 years and a BMI of 50.6 +/- 9.1 kg/m2. The co-morbidities were greater in the MC patients than in the NMC patients (hypertension 71.9% versus 48.4%, diabetes mellitus 39.72% versus 19.4%, obstructive sleep apnea 46.45% versus 28.46%, and obesity hypoventilation syndrome 9.93% versus 2.71%). The mortality rate was 2.48% in the MC patients and .76% in the NMC patients. Mortality was absent in MC patients >65 years old. The percentage of excess weight lost was less in the MC patients (60.8%) than in the NMC patients (66.5%, P obstructive sleep apnea 79.17% versus 54.51%; and obesity hypoventilation syndrome 26.39% versus 7.64%). The operative mortality rate was 5.6% for the male MC patients and 1.5% for the female MC patients. The weight loss was similar for the male MC and male NMC patients. The male MC patients had slightly better resolution of both hypertension (MC patients 54.8% versus NMC patients 26.7%, P = .0025) and diabetes mellitus (MC patients 30% versus NMC patients 22.5%, P = .745). When the patients were stratified into low-, intermediate-, and high-risk groups using a previously validated risk scale, patients with similar risk factors had similar mortality in both groups. The results of our study have shown that disabled MC patients have greater operative mortality than NMC patients that appears to be associated with more prevalent risk factors. However, the risk was counterbalanced by a substantial improvement in health.
Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown
... news/fullstory_167566.html 2 of 3 U.S. Patients Keep Unused Painkillers After Surgery Saving leftover pills, ... 2017 WEDNESDAY, Aug. 2, 2017 (HealthDay News) -- Surgery patients are usually prescribed opioids to ease postoperative pain, ...
Zhang, Junqian; Rosen, Alex; Orenstein, Lauren; Van Voorhees, Abby; Miller, Christopher J; Sobanko, Joseph F; Shin, Thuzar M; Etzkorn, Jeremy R
Biopsy site identification is critical to avoid wrong-site surgery and may impact patient-centered outcomes. We sought to evaluate risk factors for biopsy site misidentification, postponement of surgery, and patient confidence in surgical site selection and to assess the near-miss rate for wrong-site surgeries. This was a prospective observational cohort study. Near-miss wrong-site surgeries were detected and averted in 1.3% (3 of 239) of patients with biopsy site photographs. Risk factors for biopsy site misidentification by patients were 6 weeks or longer between biopsy and surgery (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.12-4.27; P = .028) and patient inability to see biopsy site (OR 3.95, 95% CI 1.50-10.37; P = .002). Risk factors for physician misidentification were 6 or more weeks between biopsy and surgery (OR 3.68, 95% CI 1.40-9.66; P = .007) and biopsy specimens from multiple sites (OR 4.39, 95% CI 1.67-11.54; P = .003). Postponement of surgery was associated with absence of a biopsy site photograph (OR 12.5, 95% CI 2.79-62.21; P postponed surgeries and improved rates of patient confidence in surgical site selection. Risk factors for biopsy site misidentification should be considered before definitive treatment. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Pitt, Henry A; Tsypenyuk, Ella; Freeman, Susan L; Carson, Steven R; Shinefeld, Jonathan A; Hinkle, Sally M; Powers, Benjamin D; Goldberg, Amy J; DiSesa, Verdi J; Kaiser, Larry R
Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Full Text Available Background. No strongly clinical evidence about the use of hand robot-assisted therapy in stroke patients was demonstrated. This preliminary observer study was aimed at evaluating the efficacy of intensive robot-assisted therapy in hand function recovery, in the early phase after a stroke onset. Methods. Seven acute ischemic stroke patients at their first-ever stroke were enrolled. Treatment was performed using Amadeo robotic system (Tyromotion GmbH Graz, Austria. Each participant received, in addition to inpatients standard rehabilitative treatment, 20 sessions of robotic treatment for 4 consecutive weeks (5 days/week. Each session lasted for 40 minutes. The exercises were carried out as follows: passive modality (5 minutes, passive/plus modality (5 minutes, assisted therapy (10 minutes, and balloon (10 minutes. The following impairment and functional evaluations, Fugl-Meyer Scale (FM, Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles (MRC, Motricity Index (MI, and modified Ashworth Scale for wrist and hand muscles (AS, were performed at the beginning (T0, after 10 sessions (T1, and at the end of the treatment (T2. The strength hand flexion and extension performed by Robot were assessed at T0 and T2. The Barthel Index and COMP (performance and satisfaction subscale were assessed at T0 and T2. Results. Clinical improvements were found in all patients. No dropouts were recorded during the treatment and all subjects fulfilled the protocol. Evidence of a significant improvement was demonstrated by the Friedman test for the MRC (P<0.0123. Evidence of an improvement was demonstrated for AS, FM, and MI. Conclusions. This original rehabilitation treatment could contribute to increase the hand motor recovery in acute stroke patients. The simplicity of the treatment, the lack of side effects, and the first positive results in acute stroke patients support the recommendations to extend the clinical trial of this
S. V. Kolesov
Full Text Available The authors presented 19 clinical observations of patients undergoing surgery at the primary idiopathic scoliosis using plate endocorrectors. The following characteristics were determined: the fixation of posterior elements of the spine there is no possibility of adequate derotation scoliotic vertebrae arc and require extensive fixation of the spine (Th2-L4, significantly reducing the functional activity of the patients. The lack of the fusion is accompanied by system micromotion, causes the instability of the upper pole of the metal construction and provokes the formation of a fistula. The presence of fibrous scar, and later - bone block, doesn’t allow to realize the lengthening effect during the patient’s growth and causes the development of Crankshaft-phenomenon, the correction of which requires a long, traumatic, multi-stage surgery.
Wilkinson, John M; Cozine, Elizabeth W; Kahn, Amir R
A variety of refractive surgery techniques, which reshape the corneal stroma using laser energy, have been marketed as simple and safe alternatives to glasses or contact lenses. Laser-assisted in-situ keratomileusis (LASIK) is the most common of these procedures. Although there are few high-quality prospective studies of long-term outcomes, complications, or stability for refractive surgery procedures, there is at least general agreement that more than 90% of appropriately selected patients achieve excellent uncorrected distance vision. In addition to well-recognized contraindications (e.g., unstable refraction, pregnancy and lactation, chronic eye disease, systemic illness, corneal abnormalities), there are other conditions that warrant caution (e.g., excessively dry eyes, contact lens intolerance, chronic pain syndromes). Postoperative dry eye, which may in part represent a corneal neuropathy, usually resolves after six to 12 months but persists in up to 20% of patients. Up to 20% of patients may have new visual disturbances, particularly with night driving. Vision-threatening complications are rare. Intraocular lenses, implanted following cataract extraction, may be an alternative to LASIK in older patients. Although the overall dependence on corrective lenses is markedly reduced, many patients still require glasses or contact lenses after LASIK, particularly in low-light conditions and as they age. Most patients report satisfaction with the results. Family physicians can help patients make informed decisions by exploring their values, preferences, expectations, and tolerance of uncertainty and risk.
Bonno van BELLEN
Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although
FitzGerald, G; Moore, G; Wilson, A P R
Healthcare workers generally underestimate the role of environmental surfaces in the transmission of infection, and compliance with hand hygiene following contact with the environment is generally lower than following direct patient contact. To reduce the risk of onward transmission, healthcare workers must identify the need to wash hands with specific tasks or events. To observe the movement of staff in critical care and general wards and determine the routes most commonly travelled and the surfaces most frequently touched with and without appropriate hand hygiene. Fifty-eight 90 min sessions of unobtrusive observation were made in open bays and isolation rooms. Link analysis was used to record staff movement from one location to another as well as the frequency of motion. Hand-hygiene audits were conducted using the World Health Organization 'five moments for hand hygiene' observational tool. In critical care, the majority of movement occurred within the bed space. The bedside computer and equipment trolley were the surfaces most commonly touched, often immediately after patient contact. In the general ward, movement between bed spaces was more common and observed hand hygiene ranged from 25% to 33%. Regardless of ward type, observed hand-hygiene compliance when touching the patient immediately on entering an isolation room was less than 30%. Healthcare workers must be made aware that bacterial spread can occur even during activities of perceived low risk. Education and intervention programmes should focus on the potential contamination of ward computers, case notes and door handles. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Mei, Lijuan; Miao, Xing; Chen, Haiying; Huang, Xiufang; Zheng, Guohua
Anxiety is the most common negative emotion among the patients awaiting coronary angiography. The increased anxiety may exacerbate coronary heart disease symptoms and possibly contribute to complications during the procedure. Chinese hand massage is a nonpharmaceutical intervention that has been used in several clinical situations in China and might have beneficial effects on reducing anxiety before coronary angiography. The aim of this study was to evaluate the effectiveness and safety of Chinese hand massage care on anxiety among patients awaiting coronary angiography. One hundred eighty-five subjects awaiting coronary angiography in a single hospital in Fuzhou, China, between May 2012 and September 2012 were screened. One hundred eligible participants were recruited and randomly assigned into the control or Chinese hand massage group. The control group received the conventional therapies and care according to the guidelines, and those in the Chinese hand massage group received additional Chinese hand massage care in conjunction with the same conventional therapies and care as the control group. The anxiety scores (evaluated by using the Hamilton Anxiety Rating Scale), heart rate, blood pressure, quality of life (Short-Form Health Survey), and the adverse events were recorded at the baseline and after coronary angiography, respectively. The scores of Hamilton Anxiety Rating Scale in the Chinese hand massage group (11.78 [SD, 2.9]) had a statistically significant decrease compared with those in the control group (15.96 [SD, 3.4]) at post-procedure (P anxiety without any adverse effects among patients awaiting coronary angiography. Therefore, it might be recommended as a nonpharmacological nursing intervention. However, future study with a larger sample size is needed to further confirm the efficacy of Chinese hand massage intervention.
Hall, Amanda M; Copsey, Bethan; Williams, Mark; Srikesavan, Cynthia; Lamb, Sarah E
To determine whether the effect of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) exercise program on hand function was mediated by changes in the proposed active ingredients: strength, dexterity, and/or range of motion. The SARAH intervention included exercises hypothesized to improve potential mediators of grip strength, pinch strength, wrist flexion, wrist extension, finger flexion, finger extension, thumb opposition, and dexterity, which would theoretically improve self-reported hand function. All variables were measured at baseline and at 4 and 12 months. Structural equation modeling was used to assess mediation on change in hand function via change in potential mediators. Change in grip strength partially mediated change in hand function. Grip strength mediated 19.4% (95% confidence interval 0.9%, 37.8%) of the treatment effect. Improvements in grip strength at 4 months are likely to mediate improved hand function at 12 months. The role of joint mobility exercises is less clear and is likely influenced by the choice of measurement tools for both mobility and function outcomes. More robust measurements of wrist and hand mobility for patients with rheumatoid arthritis may be necessary to determine the relationship between this variable and self-reported hand function. Using a large trial data set, we have demonstrated that techniques used to target grip strength are key active ingredients of the SARAH exercise program and mediate its effect. © 2016, American College of Rheumatology.
Pani, Danilo; Barabino, Gianluca; Dessì, Alessia; Tradori, Iosto; Piga, Matteo; Mathieu, Alessandro; Raffo, Luigi
Current clinical practice suggests that recovering the hand functionality lost or reduced by injuries, interventions and chronic diseases requires, beyond pharmacological treatments, a kinesiotherapic intervention. This form of rehabilitation consists of physical exercises adapted to the specific pathology. Its effectiveness is strongly dependent on the patient's adhesion to such a program. In this paper we present a novel device with remote monitoring capabilities expressly conceived for the needs of rheumatic patients. It comprises several sensorized tools and can be used either in an outpatient clinic for hand functional evaluation, connected to a PC, or afforded to the patient for home kinesiotherapic sessions. In the latter case, the device guides the patient in the rehabilitation session, transmitting the relevant statistics about his performance to a TCP/IP server exploiting a GSM/GPRS connection for deferred analysis. An approved clinical trial has been set up in Italy, involving 10 patients with Rheumatoid Arthritis and 10 with Systemic Sclerosis, enrolled for 12 weeks in a home rehabilitation program with the proposed device. Their evaluation has been performed with traditional methods but also with the proposed device. Subjective (hand algofunctional Dreiser's index) and objective (ROM, strength, dexterity) parameters showed a sustained improvement throughout the follow-up. The obtained results proved that the device is an effective and safe tool for assessing hand disability and monitoring kinesiotherapy exercise, portending the potential exploitability of such a methodology in clinical practice.
Istenes, Nancy; Bingham, James; Hazelett, Susan; Fleming, Eileen; Kirk, Jane
Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown. Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed. Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination. Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Tam, Kim-Pong; Ng, Henry Kin-Shing; Kim, Young-Hoon; Yeung, Victoria Wai-Lan; Cheung, Francis Yue-Lok
Cosmetic surgery is increasingly popular globally, but how cosmetic surgery patients are socially evaluated is largely unknown. The present research documents attitudes toward these patients in multiple cultures (Hong Kong, Japan, and the United States). Across these cultures, attitudes toward cosmetic surgery patients were predominantly negative: Participants ascribed more negative attributes to cosmetic surgery patients and found cosmetic surgery not acceptable. Also, participants in Hong Kong and Japan were not willing to form social relationships, particularly intimate ones, with these patients. These attitudes were less negative in the United States than in Hong Kong and Japan, partly because social contact, which reduced negativity in attitudes toward cosmetic surgery patients, was more prevalent in the United States. These findings bear important implications for the subjective well-being of cosmetic surgery patients, who very often expect improvement in their social relationships through the surgery.
Background The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods At stroke onset, 485 patients were initially assessed in 2007–2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain. PMID:24765589
Isaksson, Mats; Johansson, Lars; Olofsson, Ingrid; Eurenius, Eva
The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. At stroke onset, 485 patients were initially assessed in 2007-2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.
Doyle, Gregory A; Xiang, Jun; Zaman, Hina; Neiman-Hart, Holli; Maroon, Michael; Arghami, Elham; Durani, Hina; Salana, Hari; Komakula, Venugopal; King, Dana E
Despite recent national emphasis, outpatient hand washing can be less than optimal. We tested a new approach involving both patient and physician hand washing. The study consisted of 384 questionnaires, 184 from phase 1 and 200 from phase 2. Patients stated doctors washed their hands 96.6% before examining them pre-intervention and 99.5% of the time post-intervention. Patients endorsed the importance of hand washing 98.7% of the time. "Co-washing" may offer a process to increase the practice of hand washing and decrease infection risk. © 2017 Annals of Family Medicine, Inc.
Patients with cleft lip and palate frequently develop dento-facial deformity requiring orthognatic surgery. The origin of this deformity is therapeutic and surgeons are currently trying to prevent this iatrogenicity. The maxillary dento-facial deformity in these patients is a retrognathia with infragnathia, associated with endognathia, obliquity of the occlusal plane, with deviation of the superior incisive midline in case of unilateral clefts. The difficulties in the treatment of these skeletal deformities are due to the palatal, labial, and pterygomaxillary scar tissue. Orthognathic surgery is most of the time bimaxillary with a 3-dimensional movement of the jaws including maxillary advancement. The aims of surgery are occlusal, esthetic, and functional improvement. The first step is gingivoperiosteoplasty (ideally performed during childhood), orthodontic treatment including, if necessary, transversal maxillary distraction to obtain enough space to replace the lateral incisor; extraction of premolars should be avoided if possible. Planning and performing the treatment are difficult for the orthodontist and for the surgeon. Maxillary advancement by distraction may be an interesting alternative to prevent partial relapse. Obtaining normal oro-facial functions are required for a stable result. These should be monitored after the primary treatment by the whole staff, surgeons, speech therapist, and orthodontists. Performing Le Fort 1 osteotomy is more difficult than in other patients because of scar fibrosis than needs to be released. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Hill, M; Reinherz, R P; Tisa, L M
A retrospective study was undertaken to determine the importance of performing noninvasive blood flow studies on the diabetic patient population prior to undergoing elective foot surgery. Thirty diabetic patients, contemplating elective foot surgery, underwent noninvasive blood flow studies. Eighty-seven percent of these patients, with ankle/brachial indices greater than 0.6, successfully healed after surgery was performed.
Results: The mean age at the first operation was 2.7 years and the mean number of operations was 3 per patient. No patient developed graft-flap necrosis and no patients required amputations. All patients were able to perform grasping and pinching functions and families were satisfied with the cosmetic results. Conclusion: Using a two-stage surgical protocol, achieving satisfactory results with a minimal number of operations is possible in patients with Apert Syndrome. [Hand Microsurg 2015; 4(3.000: 53-57
Sanan, Akshay; Quinn, Candace; Spiegel, Jeffrey H
Plastic surgeons are competing for their share of a growing but still limited market, thus making advertising an important component in a successful plastic surgery practice. The authors evaluate the variables, characteristics, and presentation features that make print advertisements most effectively pique the interest of individuals selecting a plastic surgeon. An online survey was administered to 404 individuals with active interest in plastic surgery from 10 major metropolitan areas. Participants were presented with 5 different advertisements from plastic surgeons throughout the country and were asked a series of both closed- and open-ended questions to assess verity, quality, and marketability of each advertisement. Reponses to open-ended questions were analyzed using the Wordle program (www.wordle.net). The most frequent themes identified for all 5 ads were "Being beautiful is possible" (41%), "I could be beautiful" (24%), "Some people need surgery to be beautiful" (16%), and "Being beautiful is important" (14%). Advertisement 1-featuring 3 women and no pre- or posttreatment photography, no physician photography, and a listing of the 3 physicians' credentials but not a list of the services provided-received the highest overall preference rating. Factors including emotions felt while reading, unique qualities of the advertisement, list of procedures performed, use of models versus actual patients, and pictures of the plastic surgeons were found to contribute to the respondents' overall perception of advertisements used to market a plastic surgery practice.
Full Text Available Obesity is a well-known major risk factor of cardiovascular disease and is associated with various comorbidities. The impact of obesity on pulmonary function remains unclear. Reductions in chest wall compliance and respiratory muscle strength due to a high percent body fat and localized fat distribution contributes to impaired pulmonary function and the occurrence of adverse respiratory symptoms. Dietary modifications and pharmaceutical agents are not effective in the long-term treatment of obesity. Treatment of morbidly obese patients using bariatric surgery has increased each year, especially after the introduction of video laparoscopic techniques. Effective weight loss after bariatric surgery may improve cardiovascular disease risk factors, including diabetes, hypertension, dyslipidemia, atherosclerosis, inflammation, chronic kidney disease, obstructive sleep apnea, and obesity hypoventilation syndrome. Bariatric surgery has also been associated with significantly improved respiratory symptoms and pulmonary function. We currently present a review of principal studies that evaluated the effects of obesity on pulmonary function and the identification of anthropometric factors of obesity that correspond to the reversal of respiratory symptoms and impaired pulmonary function after bariatric surgery.
Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo
The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m2.
Golkar, Farhaad C; Ross, Sharona B; Sperry, Steffanie; Vice, Michelle; Luberice, Kenneth; Donn, Natalie; Morton, Connor; Hernandez, Jonathan M; Rosemurgy, Alexander S
Laparoendoscopic single-site (LESS) surgery can be performed without apparent scarring, while maintaining the salutary benefits of conventional laparoscopic surgery. The purpose of this study was to compare patients' preoperative and postoperative perceptions of LESS surgery. Before and after undergoing LESS surgery, 120 patients were given questionnaires; their responses were assimilated and analyzed. Of 120 patients, 62% were female (age, 52 ± 16.6 y), and 54% had prior abdominal surgery. Preoperatively, women and older patients reported heightened appearance dissatisfaction. Preoperatively, most patients would not accept more risk, pain, surgery/recovery times, and/or costs than associated with standard laparoscopy. Postoperatively, patients reported increased satisfaction in their overall and abdominal region appearance. Satisfaction was noted by 92%; satisfaction was related significantly to scar appearance and cosmesis. Preoperatively, patients were most concerned with safety; postoperatively, patients' concerns shifted to cosmetic outcome. LESS surgery provides an opportunity for improved patient satisfaction. Copyright © 2012 Elsevier Inc. All rights reserved.
Rapoliene, Jolita; Krisciūnas, Aleksandras
The aim of the study was to evaluate the effectiveness of occupational therapy in rheumatoid arthritis patients with impaired hand function. Standardized Functional Independence Measure was employed in order to evaluate the functional status of the patients and impaired activities. A dynamometer was used for the measurements of muscular strength of hands and a goniometer, for the range of motion of the wrist. Totally, we have examined 120 rheumatoid arthritis patients. They were divided into two groups: 60 patients in each. Occupational therapy was applied only to the patients of the first group. The mean age of Group 1 patients was 53.4+/-1.8 years, the mean age of Group 2 patients was 52.0+/-1.9 years. The mean duration of the disease was 11.5+/-2.6 years and 12.1+/-2.4 years, respectively. The effectiveness of therapy was considered ineffective if, after the completion of the course of occupational therapy, no increase in Functional Independence Measure score for patients with rheumatoid arthritis was observed. When the score increased from 1 to 3, we considered this as moderate effectiveness; when the score increased to 4-6, we evaluated the effectiveness of occupational therapy as good, and when the score of 7 was attained, effectiveness of occupational therapy was considered as very good. In Group 1, the moderate effectiveness of occupational therapy was determined in 31.7% of patients; good effectiveness, in 61.7%; and very good effectiveness, in 3.3% of rheumatoid arthritis patients. In Group 2, the moderate effectiveness of treatment was determined in 48.3% of patients and good effectiveness, in 5% of rheumatoid arthritis patients. CONCLUSIONS. Hand function (the strength of fingers and hands, the range of motion of the wrist) significantly improved in patients with rheumatoid arthritis after completion of a course of occupational therapy (p<0.05). The improvement of hand functions in patients with rheumatoid arthritis led to increased ability to take food
Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E
Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review. PMID:25429323
Guler-Yuksel, M.; Allaart, C.F.; Goekoop-Ruiterman, Y.P.; Bouwstra, J.K.; Groenendael, J.H.L.M.; Mallee, C.; Bois, de M.H.W.; Breedveld, F.C.; Dijkmans, B.A.C.; Lems, W.F.
Objectives: To evaluate changes in bone mineral density (BMD) in the hands, hip and spine after 1 and 2 years of follow-up, in relation to antirheumatic and antiresorptive therapies and disease and demographic variables in patients with recent-onset rheumatoid arthritis ( RA). Methods: Changes in
Misirlioglu, Tugce Ozekli; Unalan, Halil; Karamehmetoglu, Safak Sahir
Cross-sectional, clinical measurement. To investigate the validity of the Duruöz Hand Index (DHI) in the assessment of hand function in patients with tetraplegia. A total of 40 patients with tetraplegia participated. Patients' upper extremities were assessed on the level of 'body function and structure' [The American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria, upper extremity motor score (UEMS), neurologic level of injury and visual analogue scale of hand function (VAS-HF)], 'activity' [DHI and Quadriplegia index of function-short form (QIF-SF)] and 'body function and structure, activity and participation' [Health Survey Short Form-36 (SF-36)] according to International Classification of Function. The DHI showed significant correlations with UEMS, AIS, QIF-SF, VAS-HF, physical functioning and physical compound summary scores of SF-36. The DHI was found a valid method in the assessment of hand functions in patients with tetraplegia. Diagnostic III. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Opsteegh, Lonneke; Reinders-Messelink, Heleen A.; Groothoff, Johan W.; Postema, Klass; Dijkstra, Pieter U.; van der Sluis, Corry K.
Purpose Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of
Dirven, Richard; Kooijman, Piet G C; Wouters, Yannick; Marres, Henri A M
Time of adherence of adhesive baseplate housings to the neck of a laryngectomized patient is one of the main problems that account for the low number of laryngectomy patients who benefit from hands-free speech. An external neck brace (ENB 1.0) was introduced to support peristomal fixation of adhesive baseplates. A prospective randomized controlled clinical cross-over trial. A total of 28 laryngectomy patients participated in this randomized, prospective, crossover trial. All used the Provox hands-free heat and moisture exchanger (HME) valve for 1 month: 2 weeks with an ENB and 2 weeks without. The median lifetime of an adhesive baseplate without a brace was 52.5 minutes versus 210 minutes with a brace (P = .03). Four participants considered the ENB as "a little" bit of a welcome addition, nine as "quite a bit," and six as "very much" (79%) to improve hands-free speech. The ENB significantly increases the lifetime of an adhesive baseplate and therefore contributes to achieving hands-free speech for a greater number of patients with laryngectomy. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Patients with vWD do not carry an increased operative risk during elective procedures if appropriate prophylac-tic and corrective therapy is administered. Although the administration of cryoprecipitate and other blood products has traditionally been the cornerstone of treatment for vWD, the recent development of desmopressin(DDAVP for clinical use may provide an effective alternative to replacement therapy with blood products. Further laparaoscopic procedures, taking care during ryle′s tube and foley′s catheter insertion, in such patients are the safer alternative for all kind of gynecologic surgeries.