[What Psychiatrists Should Know about the Medical Documentation They Issue: Admission for Medical Care and Protection, Medical Treatment for Persons with Disabilities, Mental Health Disability Certification, etc].

Science.gov (United States)

Yamasaki, Masao

2015-01-01

Psychiatrists issue a wide variety of documentation, among which are torms such as Registration of Admission for Medical Care and Protection, Periodic Report of Condition, Certification of Medical Treatment for Persons with Disabilities, and Mental Health Disability Certification, which are required under laws such as the Act on Mental Health and Welfare for the Mentally Disabled. These documents are important in that they are related to protecting the human rights of people with mental disorders, as well as securing appropriate medical and welfare services for them. However, in the course of reviewing and evaluating documentation at our Mental Health and Welfare Center, we encounter forms which are incomplete, or which contain inappropriate content. In order to protect the human rights of people with mental disorders, and to ensure the provision of appropriate medical and welfare services for them, I call on psychiatrists to issue carefully written and appropriate documentation. In this talk I will focus primarily on what psychiatrists should know when filling in forms in the course of their day-to-day clinical work.

On the borderland of medical and disability history: a survey of the fields.

Science.gov (United States)

Linker, Beth

2013-01-01

This essay explores the multiple sites where disability appears in the history of medicine and suggests ways in which medical historians can self-consciously incorporate a disability perspective into their own work. Just as medical historians have much to learn from disability historians, disability historians could benefit from looking more closely at the history of medicine. While disability cannot (and should not) be reduced to disease, the fact remains that some forms of disability are brought about by disease processes, and some require daily regimes of home health care, therapy, and pain management. How the disabled have interacted with health care institutions, caretakers, and the medical establishment is too significant to be written out of its history.

Evaluation of nursing and medical students' attitudes towards people with disabilities.

Science.gov (United States)

Sahin, Hatice; Akyol, Asiye D

2010-08-01

The aim of this study is to assess the attitudes of students towards disabled people and provide suggestions to make necessary changes in the curricula. Disabled people suffer from rejection, exclusion and discrimination. The undergraduate education of future health professionals should include processes of critical thinking towards and analysis of the disabled. Cross-sectional design was used. All the preclinical medical and nursing students in our institution were included in study. Data were collected using the Turkish Attitudes towards Disabled Person Scale (TATDP) and demographical variables. TATDP Scale was scored according to five-point Likert Scale. Students' mean attitude score is 120.57 (SD 15.24). Subscale mean scores are 53.61 (SD 7.25) for compassion (CP), 50.47 (SDS 7.26) for social value (SV) and 16.49 (SD 2.89) for resource distribution (RD). Whilst nursing students had less contact with the disabled, medical students had a closer contact with them. Medical students acquired more prior knowledge about attitudes towards the disabled. Total attitude scores of female students were above the students' mean attitude score when compared to those of male students. Only if early contact is established with patients and the disabled, practical educational strategies are adopted, and the students are provided with information on attitudes about the disabled, will a social model of disability be introduced into the curriculum. This study results were presented to curriculum planning committees of nursing and medical schools, so that they should use them as needs assessment data in developing a disability awareness curriculum. The curriculum will be implemented in cooperation with not only schools but also other social institutions. For instance, clerkship applications will be accomplished by cooperating with nursing homes and organisations of disabled people.

Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.

Science.gov (United States)

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

2010-08-01

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

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

Science.gov (United States)

Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

2017-09-01

Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p migraine disability and highest acute medication satisfaction.

The Medicaid Medically Improved Group, Losing Disability...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in, The Medicaid Medically Improved Group, Losing Disability Status and Growing Earnings, published in Volume 4, Issue 1 of the...

Headache associated disability in medical students at the Kenyatta ...

African Journals Online (AJOL)

Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre ...

Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

Science.gov (United States)

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

2009-09-01

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

Perioperative death: Its implications and management

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J P Attri

2016-01-01

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

76 FR 44086 - Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity...

Science.gov (United States)

2011-07-22

... Medical Examination for Disability Evaluation, VA Form 21-2545. OMB Control Number: 2900-0052. Type of... of Medical Examination for Disability Evaluation) Activity Under OMB Review AGENCY: Veterans Benefits... prior to undergoing a VA examination for disability benefits. The examining physician also completes the...

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

Science.gov (United States)

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

2014-06-01

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

Discourse in Action: Parents' use of medical and social models to resist disability stigma.

Science.gov (United States)

Manago, Bianca; Davis, Jenny L; Goar, Carla

2017-07-01

For parents of children with disabilities, stigmatization is part of everyday life. To resist the negative social and emotional consequences of stigma, parents both challenge and deflect social devaluations. Challenges work to upend the stigmatizing structure, while deflections maintain the interaction order. We examine how parents of children with disabilities deploy deflections and challenges, and how their stigma resistance strategies combine with available models of disability discourse. Disability discourse falls into two broad categories: medical and social. The medical model emphasizes diagnostic labels and treats impairment as an individual deficit, while the social model centralizes unaccommodating social structures. The social model's activist underpinnings make it a logical frame for parents to use as they challenge disability stigma. In turn, the medical model's focus on individual "improvement" seems to most closely align with stigma deflections. However, the relationship between stigma resistance strategies and models of disability is an empirical question not yet addressed in the literature. In this study, we examine 117 instances of stigmatization from 40 interviews with 43 parents, and document how parents respond. We find that challenges and deflections do not map cleanly onto the social or medical models. Rather, parents invoke medical and social meanings in ways that serve diverse ends, sometimes centralizing a medical label to challenge stigma, and sometimes recognizing disabling social structures, but deflecting stigma nonetheless. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perioperative anaphylaxis

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Marta Inés Berrío Valencia

2015-08-01

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

Peri-operative cognitive dysfunction and protection

DEFF Research Database (Denmark)

Steinmetz, J; Rasmussen, L S

2016-01-01

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

Neoadjuvant Treatment Does Not Influence Perioperative Outcome in Rectal Cancer Surgery

International Nuclear Information System (INIS)

Ulrich, Alexis; Weitz, Juergen; Slodczyk, Matthias; Koch, Moritz; Jaeger, Dirk; Muenter, Marc; Buechler, Markus W.

2009-01-01

Purpose: To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. Methods and Materials: This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. Results: A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m 2 (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. Conclusion: The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.

A Dog Is a Doctor’s Best Friend: The Use of a Service Dog as a Perioperative Assistant

Directory of Open Access Journals (Sweden)

Shannon Tew

2016-01-01

Full Text Available Service dogs are beneficial in providing assistance to people with multiple types of disabilities and medical disorders including visual impairment, physical disabilities, seizure disorders, diabetes, and mental illness. Some service animals have been trained as a screening tool for cancer. We review a case involving a 6-year-old female with a history of mast cell mediator release and immediate hypersensitivity due to the urticaria pigmentosa variant of cutaneous mastocytosis who underwent a cystourethroscopy. Her service dog, JJ, who would alert to mast cell mediator release, was used throughout the perioperative course as a means of anxiolysis and comfort and to monitor for mast cell mediator release. This case presents an example of a service dog used in a family-care model in the field of anesthesiology and provides a unique example of using a service dog as an additional monitor to alert the care team for impending mast cell mediator release.

Perioperative management of children with obstructive sleep apnea.

Science.gov (United States)

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

2009-07-01

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

Intellectual disability health content within medical curriculum: an audit of what our future doctors are taught.

Science.gov (United States)

Trollor, Julian N; Ruffell, Beth; Tracy, Jane; Torr, Jennifer J; Durvasula, Seeta; Iacono, Teresa; Eagleson, Claire; Lennox, Nicolas

2016-04-11

There is a high burden of unmet health needs for people with intellectual disability. Despite experiencing significantly higher rates of morbidity and mortality compared with the general population, this group faces greater barriers to accessing healthcare. While increasing workplace capacity is one way to reduce this inequitable access, previous research indicates a scarcity of undergraduate teaching in intellectual disability. The aim of the study was to determine the extent and nature of intellectual disability content currently offered within medical degree curricula. All Australian universities (n = 20) providing accredited medical training were invited to participate in a two-phase audit via an email invitation to the Dean of each medical school. The Dean's delegate from 14 medical schools completed Phase 1, which involved a questionnaire or telephone interview about the overall medical course structure. Unit coordinators and/or teaching staff from 12 medical schools completed Phase 2, which involved an online survey about intellectual disability content within the curriculum. In Australia, medical school curricula contain a median of 2.55 h of compulsory intellectual disability content. The majority of universities only offer a small amount of compulsory content. Of compulsory units, intellectual disability teaching is minimal in sexual health and emergency medicine (only one unit offered in one school for each). Topics of key relevance in intellectual disability health such as human rights issues, interdisciplinary team work and preventative health are poorly represented in intellectual disability teaching. Elective content varies markedly across universities (1 to 122 h), but emergency medicine, women's health, men's health and many other specialist medicine areas are not represented. Inclusive practice is inconsistent in degree and nature, but a majority of universities (nine) involve people with intellectual disability in the development or delivery

A theoretical framework to describe communication processes during medical disability assessment interviews

Directory of Open Access Journals (Sweden)

Schellart Antonius JM

2009-10-01

Full Text Available Abstract Background Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. Objective The objective of this paper is to describe the conceptualisation of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. Conceptualisation The behavioural model, based on the Theory of Planned Behaviour (TPB, is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction, intentions, attitudes, skills, and barriers for communication. Conclusion The conceptualisation of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments.

Errors in the administration of intravenous medications in patients undergoing anesthesia in the operating room

Directory of Open Access Journals (Sweden)

Juan David Miranda

2013-03-01

Full Text Available Errors in medication administration have affected the anesthetic practice over the time and have become a major cause of perioperative morbidity and mortality. Among different medical specialties, anesthesiology is perhaps the most likely to make mistakes in this procedure. This is because in many places around the world, a single professional "anesthesiologist" orders, prepares and administers a drug at one time and setting. For thirty years, Cooper disclosed the first reports of critical incidents and perioperative safety scheme, and in the 90s', Chopra performed a retrospective analysis, found that medication errors are the fourth most common that results in disability in 17% and death in 8%, these being preventable errors in 51% of cases. It’s essential for the safe practice of anesthesia to establish interventions for improving prevention programs, education, research and development, enabling break traditional paradigms, with the aim of making recommendations and standardize the safe administration of drugs in this field.

The clinical nurse leader in the perioperative setting: a preceptor experience.

Science.gov (United States)

Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

2014-07-01

The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems.

Science.gov (United States)

Scheifes, Arlette; Egberts, Toine C G; Stolker, Joost Jan; Nijman, Henk L I; Heerdink, Eibert R

2016-07-01

Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs. © 2015 John Wiley & Sons Ltd.

Psychiatric Services for Individuals with Intellectual and Developmental Disabilities: Medication Management

Science.gov (United States)

Russell, Andrew T.; Hahn, Joan Earle; Hayward, Katharine

2011-01-01

The purpose of this study was to describe the medication management and treatment provided in a specialty outpatient psychiatry clinic for 198 community-residing children and adults with intellectual disability and other developmental disabilities (IDD) referred to the clinic and discharged between 1999 and 2008. Using a descriptive design, data…

Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines.

Science.gov (United States)

Grunebaum, Lisa Danielle; Reiter, David

2006-01-01

To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

Investigation of medical board reports of disability due to mental health problems

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Mesut Yildiz

2016-06-01

Conclusion: We think that this report might be helpful for regulations related to disabled people, and might guide adult psychiatric services for patients who present to medical boards for disability due to mental health problems. [Cukurova Med J 2016; 41(2.000: 253-258

Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician

Directory of Open Access Journals (Sweden)

Misra L

2017-02-01

Full Text Available Lopa Misra,1 Norio Fukami,2 Katarina Nikolic,1 Terrence L Trentman1 1Department of Anesthesiology, 2Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, AZ, USA Abstract: Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Although nonsurgical treatments such as pneumatic dilatation of the distal esophagus and botulinum toxin injections have been performed, these procedures have limited duration. Similarly, surgical treatment with Heller myotomy is associated with complications. At our institution, we perform the peroral endoscopic myotomy (POEM in qualified patients. Briefly, POEM involves endoscopic creation of a mid-esophageal submucosal bleb, creation of a submucosal tunnel with the endoscope, and then a distal myotomy, resulting in relaxation of the distal esophagus. The aim of our study is to document perioperative pain and associated pain management for our initial patients undergoing POEM and to review the literature for perioperative complications of this procedure. Therefore, anesthetic and pain management for our initial eleven patients undergoing POEM were reviewed. Patient demographics, pre-POEM pain medication history, perioperative pain medication requirements, and post-POEM pain scores were examined. We found post-POEM pain was usually in the mild–moderate range; a combination of medications was effective (opioids, nonsteroidal anti-inflammatory drugs, acetaminophen. Our literature search revealed a wide frequency range of complications such as pneumoperitoneum and subcutaneous emphysema, with rare serious events such as capnopericardium leading to cardiac arrest. In conclusion, our experience with POEM suggests pain and can be managed adequately with a combination of medications; the procedure appears to be safe and reasonable to perform in an outpatient endoscopy unit. Keywords: pain management, retrospective study, combination of medicines, perioperative, endoscopy

Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.

Science.gov (United States)

Sadhasivam, Senthilkumar; Cohen, Lindsey L; Hosu, Liana; Gorman, Kristin L; Wang, Yu; Nick, Todd G; Jou, Jing Fang; Samol, Nancy; Szabova, Alexandra; Hagerman, Nancy; Hein, Elizabeth; Boat, Anne; Varughese, Anna; Kurth, Charles Dean; Willging, J Paul; Gunter, Joel B

2010-04-01

Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments. The PACBIS was used to assess the perioperative behaviors of 89 children aged 3 to 12 years presenting for adenotonsillectomy and their parents. Assessments using the PACBIS were made during perioperative events likely to prove distressing to children and/or parents (perioperative measurement of blood pressure, induction of anesthesia, and removal of the IV catheter before discharge). Static measurements of perioperative anxiety and behavioral compliance during anesthetic induction were made using the modified Yale Preoperative Anxiety Scale and the Induction Compliance Checklist (ICC). Each event was videotaped for later scoring using the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) and Observational Scale of Behavioral Distress (OSBD). Interrater reliability using linear weighted kappa (kappa(w)) and multiple validations using Spearman correlation coefficients were analyzed. The PACBIS demonstrated good to excellent

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

Science.gov (United States)

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

2015-06-01

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

Patient-centered medical homes for patients with disabilities.

Science.gov (United States)

Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

2015-01-01

The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

Does Coordinated, Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

Science.gov (United States)

Ziemke, Gregg; Campello, Marco; Hiebert, Rudi; Weiner, Shira Schecter; Rennix, Chris; Nordin, Margareta

2015-09-01

Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team. Is a multidisciplinary spine team effective in limiting disability and attrition related to work-disabling spine conditions as compared with the current standard of care for US military active-duty service members? This is a retrospective, pre-/post-study with a separate, concurrent control group using administratively collected data from two large military medical centers during the period 2007 to 2009. In this study, disability is expressed as the proportion of active-duty service members seeking treatment for a work-disabling spine condition that results in the assignment of a first-career limited-duty status. Attrition is expressed as the proportion of individuals assigned a first-career limited-duty status for a work-disabling spine condition who were referred to a Physical Evaluation Board. We analyzed 667 individuals assigned a first-career limited-duty for a work-disabling spine condition between 2007 and 2009 who received care at the Naval Medical Center Portsmouth or Naval Medical Center San Diego. Rates of first-career limited-duty assignments for spine conditions decreased from 2007 to 2009 at both sites, but limited-duty rates decreased to a greater extent at the intervention site (Naval Medical Center Portsmouth; from 8.5 per 100 spine cases in 2007 to 5.1 per 100 cases in 2009, p Team was

Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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Polderman JAW

2016-05-01

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

Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician

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Misra, Lopa; Fukami, Norio; Nikolic, Katarina; Trentman, Terrence L

2017-01-01

Achalasia refers to the lack of smooth muscle relaxation of the distal esophagus. Although nonsurgical treatments such as pneumatic dilatation of the distal esophagus and botulinum toxin injections have been performed, these procedures have limited duration. Similarly, surgical treatment with Heller myotomy is associated with complications. At our institution, we perform the peroral endoscopic myotomy (POEM) in qualified patients. Briefly, POEM involves endoscopic creation of a mid-esophageal submucosal bleb, creation of a submucosal tunnel with the endoscope, and then a distal myotomy, resulting in relaxation of the distal esophagus. The aim of our study is to document perioperative pain and associated pain management for our initial patients undergoing POEM and to review the literature for perioperative complications of this procedure. Therefore, anesthetic and pain management for our initial eleven patients undergoing POEM were reviewed. Patient demographics, pre-POEM pain medication history, perioperative pain medication requirements, and post-POEM pain scores were examined. We found post-POEM pain was usually in the mild–moderate range; a combination of medications was effective (opioids, nonsteroidal anti-inflammatory drugs, acetaminophen). Our literature search revealed a wide frequency range of complications such as pneumoperitoneum and subcutaneous emphysema, with rare serious events such as capnopericardium leading to cardiac arrest. In conclusion, our experience with POEM suggests pain and can be managed adequately with a combination of medications; the procedure appears to be safe and reasonable to perform in an outpatient endoscopy unit. PMID:28260955

Perioperative Vision Loss in Cervical Spinal Surgery.

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

2017-04-01

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

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

Directory of Open Access Journals (Sweden)

Miguel L. Tedde

2012-11-01

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

Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

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Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

2015-01-01

Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

The challenge of perioperative pain management in opioid-tolerant patients

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

2017-01-01

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

The unfinished body: the medical and social reshaping of disabled young bodies.

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McLaughlin, Janice; Coleman-Fountain, Edmund

2014-11-01

Stories about disability are heavily shaped by the narratives offered by medicine and society. Those narratives enact an 'anomalous' body that is constructed as distant from the norm and therefore 'damaged' but also fixable. In this paper we explore how such narratives, and the practices they encompass, influence the stories disabled young people tell about their bodies and impairment. We do so by drawing on narrative qualitative interviews and visual practices carried out with seventeen disabled young people in a project funded by the Economic and Social Research Council that took place between 2011 and 2012 in the North East of England. The findings discussed here focus on how medical and societal responses to bodily difference become part of the stories disabled young people tell about their bodies, and influence the way they work with the body as something which remains 'unfinished' and therefore both fixable and flawed. Our conclusion is that a narrative of an unfinished body is produced, as young people manage their bodies as something that is integral to their emerging identity, but also as a potential threat that could undermine and give away their labour in making an 'ordinary' functioning body and life. The paper contributes to medical sociology and sociology of the body by producing new knowledge about how disabled embodiment is lived and framed by disabled young people in the context of ongoing attempts to change the body. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Perioperative Management of Neurological Conditions

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Manjeet Singh Dhallu

2017-06-01

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

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

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

2018-01-01

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

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

Science.gov (United States)

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

2018-02-01

approach for airway management. Optimal management of the perioperative care of Duchenne muscular dystrophy patients requires input from relevant medical specialists, proceduralist and anesthesiologist. This complexity of care coordination presents an opportunity for anesthesiologists to lead a collaborative perioperative team in management of advanced Duchenne patients coming for gastrostomy. © 2017 John Wiley & Sons Ltd.

78 FR 12130 - Social Security Ruling, SSR 13-3p; Appeal of an Initial Medical Disability Cessation...

Science.gov (United States)

2013-02-21

... determination. This Ruling also clarifies how this policy applies at the Appeals Council (AC) level when the AC.... Policy Interpretation Ruling Title II: Appeal of an Initial Medical Disability Cessation Determination or...; Appeal of an Initial Medical Disability Cessation Determination or Decision AGENCY: Social Security...

Medical Students' Attitudes towards Health Care for People with Intellectual Disabilities: A Qualitative Study

Science.gov (United States)

Ryan, Travis A.; Scior, Katrina

2016-01-01

Background: People with intellectual disabilities experience serious health inequalities (e.g. they die younger than people without intellectual disabilities). Medical students' attitudes towards health care for this population warrant empirical attention because, as tomorrow's doctors, they will affect the health inequalities that people with…

Danish Perioperative Nurses' Documentation

DEFF Research Database (Denmark)

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

2017-01-01

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

Role of Health Information Technology (HIT) in disability determinations: when medical records become medical evidence.

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Tulu, Bengisu; Daniels, Susan; Feldman, Sue; Horan, Thomas A

2008-11-06

This exploratory study investigated the impact of incomplete medical evidence on the SSA disability determination process and the role of HIT as a solution. We collected qualitative data from nineteen expert-interviews. Findings indicate that HIT can lead to innovative solutions that can significantly improve the determination process.

Implementing a Perioperative Nursing Student Summer Internship.

Science.gov (United States)

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

2018-01-01

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

Antipsychotic Medication Prescription Patterns in Adults with Developmental Disabilities Who Have Experienced Psychiatric Crisis

Science.gov (United States)

Lunsky, Yona; Elserafi, Jonny

2012-01-01

Antipsychotic medication rates are high in adults with developmental disability. This study considered rates of antipsychotic use in 743 adults with developmental disability who had experienced a psychiatric crisis. Nearly half (49%) of these adults were prescribed antipsychotics. Polypharmacy was common with 22% of those prescribed antipsychotics…

Oral surgery in patients under antithrombotic therapy: perioperative bleeding as a significant risk factor for postoperative hemorrhage.

Science.gov (United States)

Rocha, Amanda L; Souza, Alessandra F; Martins, Maria A P; Fraga, Marina G; Travassos, Denise V; Oliveira, Ana C B; Ribeiro, Daniel D; Silva, Tarcília A

2018-01-01

: To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures. A total of eight cases of perioperative and 12 episodes of postoperative bleeding were documented. The complications were generally managed with local measures and did not require hospitalization. We found significant association of postoperative hemorrhage with increased perioperative bleeding (P = 0.043) and combination of anticoagulant and antiplatelet therapy (P bleeding is 8.8 times bigger than procedures without perioperative bleeding. Dental surgery in patients under antithrombotic therapy might be carried out without altering the regimen because of low risk of perioperative and postoperative bleeding. However, patients with increased perioperative bleeding should be closely followed up because of postoperative complications risk.

[Current status and prospect of perioperative thrombus management in gastrointestinal cancer].

Science.gov (United States)

Qin, X Y

2016-03-01

Thanks to the progress of surgical theory and skills, as well as the application of modern medical devices in general surgery, both the occurrence of perioperative complications and mortality of gastrointestinal surgery have significantly reduced recently. However, it is still far from optimal in terms of the perioperative venous thromboembolism (VTE) management in gastrointestinal cancer, and what is responsible for that? This paper aims at finding out the reasons contributing to the current status, giving suggestions for how to make improvement at both disease level and hospital management level. At the same time, while paying attention for the prophylaxis of VTE, there have been more and more patients receiving antithrombotic treatment require elective or emergent surgery in clinical practice, due to aging and increased incidence of cardiovascular disease year by year. How to balance the bleeding and thrombosis risk for these patients during perioperative periods is also a question we are going to discuss. In conclusion, as to the issue of the management of perioperative thrombosis, there will be a long way for Chinese doctors to go. Our peers should pay more attention to this problem and take more efforts, so that the thrombotic complications in surgical patients can be reduced.

The challenge of perioperative pain management in opioid-tolerant patients

Directory of Open Access Journals (Sweden)

Coluzzi F

2017-09-01

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

Changes in Temporary Disability Reporting Following the Implementation of the Army Medical Readiness Transformation.

Science.gov (United States)

Sapp, Jason E; Cody, Matthew J; Douglas, Kevin M

2018-02-07

In November 2014, the U.S. Army held a readiness summit to address concerns about the accuracy of medical reporting systems. At the time, soldiers on temporary disability were tracked as a medical readiness classification (MRC) 3A or 3B. MRC 3A soldiers had a medical condition with recovery expected within 30 d and MRC 3B soldiers were expected to take longer than 30 d to recover. Both groups were considered "non-available" and presumably non-deployable. Starting June 1, 2016, with the implementation of the Army Medical Readiness Transformation, soldiers on temporary disability longer than 14 d began to be reported as MRC 3s and are considered "non-deployable." The purpose of this study is to compare the number of soldiers on temporary disability previously reported as MRC 3A and 3B to the number listed as MRC 3 under the new reporting system for a light infantry brigade and to quantify the types and relative percentage of medical conditions leading to temporary disability under the new system. This cross-sectional analysis was conducted between January 1 and December 31, 2016 at Fort Carson, Colorado and included all soldiers assigned to Second Brigade, Fourth Infantry Division. We calculated the average number and proportion of soldiers on temporary disability at any one time for the period prior to implementation of the new reporting system (January 1 through May 31, 2016) and compared this to the period after implementation on June 1, 2016. The difference between the two independent proportions was calculated along with the lower and upper limits of the 95% confidence interval for the difference. Between January 1 and May 31, 2016, the average number of soldiers on temporary disability at any one time was 186, accounting for 4.3% of the authorized unit strength. After June 1, 2016, the average number increased to 244 or 5.7%. The difference in the proportion of temporary profiles was 1.4% (95% confidence interval 0.43-2.3%). From June 1 through December 31

Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

Science.gov (United States)

Dexter, Franklin; Epstein, Richard H

2015-12-01

As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement

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

Science.gov (United States)

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

2018-01-15

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

Nitrous oxide and perioperative outcomes.

Science.gov (United States)

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

2014-06-01

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

Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview.

Science.gov (United States)

Gualtierotti, Roberta; Parisi, Marco; Ingegnoli, Francesca

2018-04-01

Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.

USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

Directory of Open Access Journals (Sweden)

V. V. Samoylenko

2015-09-01

Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

Physical practice is associated with less functional disability in medical students with migraine

OpenAIRE

Domingues,Renan B.; Teixeira,Antônio Lúcio; Domingues,Simone A.

2011-01-01

The aim of this study was to investigate possible association between migraine and physical practice among 480 medical students who were submitted to a questionnaire about headaches and physical practices. Migraine diagnosis was assessed by ID-Migraine and functional disability was evaluated with MIDAS. The type (aerobic or strength training), the weekly frequency and the intensity of physical practice and body mass index (BMI) were assessed. There was a reduction in functional disability of ...

Attitudes towards people with physical or intellectual disabilities among nursing, social work and medical students.

Science.gov (United States)

Kritsotakis, George; Galanis, Petros; Papastefanakis, Emmanouil; Meidani, Flora; Philalithis, Anastas E; Kalokairinou, Athena; Sourtzi, Panayota

2017-12-01

To examine and compare undergraduate healthcare students' attitudes towards people with physical or intellectual disabilities in Greece. The experience that people with disabilities have with health care is a complex interaction between their medical condition and the social and physical environment. Attitudes of the nursing and healthcare staff affect the quality of care and people's adaptation to their disability, self-image and rehabilitation outcomes. Descriptive cross-sectional survey. Nursing, Social Work and Medicine students (N = 1007, 79.4% female) attending three universities (Athens, Crete) completed during 2014-2016 two standardised scales regarding physical (ATDP-B) and intellectual disability (CLAS-ID). Descriptive and multivariate logistic regression analyses were performed. Attitudes towards people with physical disabilities in Greece (ATDP-B scores) were poor with scores just above the mid-point. Medical studies and higher knowledge and work with individuals with physical disabilities signified marginally more positive attitudes. Gender and age displayed no associations with attitudes. Regarding intellectual disability (CLAS-ID scores), nursing students had slightly less positive attitudes in "Similarity" but more positive attitudes in "Sheltering" subscales. Previous work and contact was related to more favourable and higher age to less favourable "Similarity" and "Sheltering" attitudes. Males had higher "Exclusion" scores. Those who knew people with intellectual disabilities had less favourable "Empowerment" attitudes. Knowledge was related to more positive attitudes in all four CLAS-ID subscales. Greek health and social care students showed poor attitudes towards people with physical and intellectual disability. When holding unfavourable attitudes, healthcare professionals become less involved with the people they care for and they do not provide nursing care to the best of their abilities. Undergraduate and continuing education, along with

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

Science.gov (United States)

Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

2017-08-01

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

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Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

2017-09-01

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

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

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

2014-01-01

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

A Systematic Approach to Creation of a Perioperative Data Warehouse.

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

2016-06-01

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

Care coordination, the family-centered medical home, and functional disability among children with special health care needs.

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Litt, Jonathan S; McCormick, Marie C

2015-01-01

Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability. Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs. There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services. Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Medication therapy management and complex patients with disability: a randomized controlled trial.

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Chrischilles, Elizabeth A; Doucette, William; Farris, Karen; Lindgren, Scott; Gryzlak, Brian; Rubenstein, Linda; Youland, Kelly; Wallace, Robert B

2014-02-01

Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module. mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs. general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time. Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.

Avoiding genetic genocide: understanding good intentions and eugenics in the complex dialogue between the medical and disability communities.

Science.gov (United States)

Miller, Paul Steven; Levine, Rebecca Leah

2013-02-01

The relationship between the medical and disability communities is complex and is influenced by historical, social, and cultural factors. Although clinicians, health-care researchers, and people with disabilities all work from the standpoint of the best interest of disabled individuals, the notion of what actually is "best" is often understood quite differently among these constituencies. Eugenics campaigns, legal restrictions on reproductive and other freedoms, and prenatal testing recommendations predicated on the lesser worth of persons with disabilities have all contributed toward the historic trauma experienced by the disability community, particularly with respect to medical genetics. One premise of personalized medicine is that different individuals require different solutions. Disabled persons' experiences are a reminder that these solutions can be best realized by maintaining awareness and sensitivity in a complex ethical and moral terrain. Geneticists should recognize that their research may have implications for those with disabilities; they should recognize the impact of the historical trauma of the eugenics movement, and seek to involve people with disabilities in discussions about policies that affect them. Dialogue can be messy and uncomfortable, but it is the only way to avoid the mistakes of the past and to ensure a more equitable, and healthful, future.

Evidence for the perioperative care of mastectomized women

Directory of Open Access Journals (Sweden)

Carla Monique Lopes Mourão

2014-01-01

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

Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

Science.gov (United States)

Binns-Turner, Pamela G; Wilson, Lynda Law; Pryor, Erica R; Boyd, Gwendolyn L; Prickett, Carol A

2011-08-01

There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer.

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

Science.gov (United States)

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

2017-08-01

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

Chronic medical conditions and mental health in older people : disability and psychosocial resources mediate specific mental health effects

NARCIS (Netherlands)

Ormel, J; Kempen, GIJM; Penninx, BWJH; Brilman, EI; Beekman, ATF; VanSonderen, E

Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental

Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care

Science.gov (United States)

Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald

2016-01-01

Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

Habits in perioperative nursing culture.

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Lindwall, Lillemor; von Post, Iréne

2008-09-01

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

Cross-Country Differences in the Additive Effects of Socioeconomics, Health Behaviors and Medical Comorbidities on Disability among Older Adults with Heart Disease.

Science.gov (United States)

Assari, Shervin

2015-01-01

Patients with heart disease experience limited activities of daily living (ADL). This is a cross-country comparison of the additive effects of Socioeconomics, health behaviors, and the number of medical comorbidities on disability among patients with heart disease. The current study used a cross-sectional design. Data came from the Research on Early Life and Aging Trends and Effects (RELATE). The current analysis utilized data on elderly individuals (age ≥60 y) from 13 countries. The outcome was any ADL limitation (i.e. bathing, dressing, using toilet, transferring, lifting heavy things, shopping, and eating meals). Socioeconomics (i.e. age, gender, education, and income), health behaviors (i.e. exercise, smoking, and drinking), and number of chronic medical conditions (i.e. hypertension, respiratory, arthritis, stroke, and diabetes) were entered into country-specific logistic regressions, considering at least one limitation in ADL as the main outcome. Number of comorbid medical conditions and age were positively associated with disability in 85% of the countries. Physical activity and drinking were linked to disability in 54%and 31% of countries, respectively. Higher education and income were associated with lower disability in 31% and 23% of the countries, respectively. Female gender was associated with higher disability only in 15% of the countries. Smoking was not associated with disability, while the effects of socioeconomics, drinking, exercise, and medical comorbidities were controlled. Determinants of disability depend on the country; accordingly, locally designed health promotion interventions may be superior to the universal interventions for patients with heart disease. Medical comorbidities, however, should be universally diagnosed and treated.

[Medical assessment of occupational disability (preparation of a list of occupational diseases with the colaboration of scientific societies)].

Science.gov (United States)

Jardón-Dato, E

Amongst the financial benefits given by the Social Security Service, that of disability benefit is one of the most important. To determine the right to obtain this and the amount due, it is necessary to have administrative certification of the existence of this disability, the cause of it and the degree (partial, total, absolute or great disability). Therefore medical assessment is essential. The medical assessors of the Disability Tribunals of the Instituto Nacional de la Seguridad Social are responsible for medical assessment. It is necessary for these doctors to understand all types of disorders and useful for them to have methodology at their disposal for each of the different disorders. Also, lack of official criteria for evaluation, due to the variety of situations which may arise, make unification difficult. We aim to devise criteria for evaluation of the diagnosis, by means of the tests and investigations necessary, their evaluation and the symptoms of each disorder which may cause problems (deficiencies) in the individual person, when carrying out his work (determining which tests and investigations allow this to be shown). Neurology is one of the specialities which offers the greatest difficulty to nonspecialists. This is due to the evaluation of complementary tests used and the subjectivity of some defects. In this paper, we aim to report these difficulties in order to promote collaboration between medical assessors and Neurology specialists.

Levosimendan for Perioperative Cardioprotection: Myth or Reality?

Science.gov (United States)

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

2018-03-21

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

Universal definition of perioperative bleeding in adult cardiac surgery

NARCIS (Netherlands)

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

2014-01-01

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

Optimal glucose management in the perioperative period.

Science.gov (United States)

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

2015-04-01

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

Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Perioperative Liver-Related Complications Following Liver Resection for Colorectal Cancer Metastases

DEFF Research Database (Denmark)

Amptoulach, S.; Gross, G.; Sturesson, C.

2017-01-01

-related). In multivariate regression analysis, the aspartate aminotransferase-to-platelet ratio index was independently associated with liver-related complications (odds ratio: 1.149, p = 0.003) and perioperative liver failure (odds ratio: 1.155, p = 0.012). The latter was also true in the subcohort of patients......Background and Aims: There are limited data on the potential role of preoperative non-invasive markers, specifically the aspartate-to-alanine aminotransferase ratio and the aspartate aminotransferase-to-platelet ratio index, in predicting perioperative liver-related complications after hepatectomy...... collected from medical records. The nontumorous liver parenchyma in the surgical specimens of 31 patients was re-evaluated. Results: Overall, 215 patients were included. In total, 40% underwent neoadjuvant chemotherapy and 47% major resection, while 47% had perioperative complications (6% liver...

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

Directory of Open Access Journals (Sweden)

WANG Hua

2014-11-01

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

Perioperative corticosteroids for intermittent and mild persistent asthma

Directory of Open Access Journals (Sweden)

Hiroto Matsuse

2002-01-01

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

Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation.

Science.gov (United States)

Chan, Andrew K; Winkler, Ethan A; Jacques, Line

2016-07-01

OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.

Using a flipped classroom and the perspective of families to teach medical students about children with disabilities and special education.

Science.gov (United States)

Sheppard, Mary E; Vitalone-Raccaro, Nancy; Kaari, Jacqueline M; Ajumobi, Taiwo T

2017-10-01

The need to teach medical students to care for children with disabilities, work effectively with these patients' families, and collaborate with schools has been well established. Yet, what is not clear is the exact nature of the content to be taught and how medical schools develop the systems and enabling structures required to ensure medical education responds to the needs of children with disabilities and their families. The aim of this study was to develop and assess the efficacy of an educational intervention designed to introduce the topics of special education law and practices and working with parents of children with disabilities into an undergraduate medical education pediatrics course. A new curricular element based upon the flipped classroom that included an on-line module followed by participation in a panel discussion comprised of parents of children with disabilities, and concluding with an on-line discussion was implemented. Medical students completed a pre- and post-assessment that evaluated their knowledge of special education law and practices. Students demonstrated increased understanding of special education laws and practices. Qualitative findings showed that students recognized the importance and value of learning the content to support their patients and their patients' families. Based upon study findings, the flipped classroom method improved student knowledge of the topic and students reported they valued the content. This addition to the undergraduate medical curriculum provided students with an effective introductory overview and demonstrated one viable option for incorporating necessary topics into the undergraduate medical curriculum. Copyright © 2017 Elsevier Inc. All rights reserved.

Learning from Physicians with Disabilities and Their Patients.

Science.gov (United States)

DeLisa, Joel A; Lindenthal, Jacob Jay

2016-10-01

Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities. It is hoped these data would be used by counselors, administrators, and admissions committees in advising medical school applicants with disabilities and in revising institutional policies with a view to increasing matriculation and graduation rates of medical students with disabilities. © 2016 American Medical Association. All Rights Reserved.

Perioperative nursing in public university hospitals

DEFF Research Database (Denmark)

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

2014-01-01

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

Management of severe perioperative bleeding

DEFF Research Database (Denmark)

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

2017-01-01

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

Perioperative beta blockers in patients having non-cardiac surgery

DEFF Research Database (Denmark)

Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

2008-01-01

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

Preventing work disability among employees with rheumatoid arthritis: what medical professionals can learn from the patients' perspective

NARCIS (Netherlands)

Varekamp, Inge; Haafkens, Joke A.; Detaille, Sarah I.; Tak, Paul P.; van Dijk, Frank J. H.

2005-01-01

OBJECTIVE: To compare the perspectives of employees with rheumatoid arthritis (RA) with those of medical professionals regarding what persons with RA need to prevent work disability. METHODS: Concept mapping was conducted in a group session with 21 employees and by mail with 17 medical

Disability management: corporate medical department management of employee health and productivity.

Science.gov (United States)

Burton, W N; Conti, D J

2000-10-01

This study describes a proactive in-house program for managing short-term disability (STD) in the workforce of a very large banking system. The goals of this program were to (1) minimize the personal and economic impacts of STD by early intervention, (2) validate the extent and duration of STD, and (3) coordinate medical services and provide guidance to managers that would facilitate an early return to work. This program was made possible by the installation of a comprehensive database, called Occupational Medicine and Nursing Information System. This database mainly includes employees' claims for inpatient and outpatient health services, disability and workers' compensation benefits, wellness program participation, medical examinations and laboratory tests, use of prescription drugs, and results of Health Risk Appraisals. As a result of these efforts, STD event duration declined after this STD management program was implemented in locations heretofore outside the system, and by providing full pay for part-time work after STD, within the system as well. Of note, the average number of STD days per employee showed substantial variation by health plan, including the fact that it was higher (3.9 STD days/employee) for health maintenance organization participants than for indemnity plan members (2.7 STD days/employee).

Perioperative nutritional support.

Science.gov (United States)

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

2014-01-01

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

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

Science.gov (United States)

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

2018-01-01

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

DISABILITY AND MEDICAL REHABILITATION. ANALYSIS OF BARRIERS AND RECOMMENDATIONS PROPOSED BY THE WORLD HEALTH ORGANIZATION

Directory of Open Access Journals (Sweden)

DOGARU Gabriela

2014-02-01

Full Text Available Disability is part of human condition. Anyone can suffer at a certain point in life a temporary or permanent disability. Disability refers to difficulties found in any of the three areas of functioning and is the term for impairments, activity limitations, and participation restrictions, which refer to the negative aspects of the interaction between an individual (with a certain health condition and the contextual factors of that individual (personal factors – motivation, self-esteem, and environmental factors – products and technology, service systems, policies, relations with the others. The concept of disability is related to human rights because: people with disabilities are confronted with injustice when they are denied employment, education, political participation; they are subject to violence, abuse, prejudice, disrespect. Medical rehabilitation measures are aimed at functions and structures of the body, activities and social participation, environmental and personal factors. The results of rehabilitation are the benefits and changes in the functioning of an individual during the course of time, which can be attributed to a single measure or to a set of measures.

Evolution and revision of the Perioperative Nursing Data Set.

Science.gov (United States)

Petersen, Carol; Kleiner, Cathy

2011-01-01

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

Introducing a music program in the perioperative area.

Science.gov (United States)

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

1997-10-01

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

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

Science.gov (United States)

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

2016-03-01

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

Perioperative Evaluation of Pregnant Surgical Patients: A Review

Directory of Open Access Journals (Sweden)

Manu Gupta

2016-06-01

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

Medication and supplement use in older people with and without intellectual disability: An observational, cross-sectional study.

Directory of Open Access Journals (Sweden)

Jure Peklar

Full Text Available Understanding the medication and supplement use of aging people is critical to ensuring that health service providers in primary care can optimise use of these agents. An increasing number of people with different levels of intellectual disability (ID are living in the community and becoming for the first time substantial users of primary health care services. This, however, brings new challenges that need to be addressed at the primary health care level. We quantified the use of medicines and food supplements and described the associated patterns of morbidity in the two comparable cohorts of aging population with and without intellectual disability.This research aligned participants of 50 years and over who lived in the community from two nationally representative cohorts of older people; those with ID from the Intellectual Disability Supplement (n = 238 and those without ID (n = 8,081 from the Irish Longitudinal Study on Ageing.Data showed that both medication and supplement use in the two groups was prevalent but that those with ID received more of both medications and supplements (e.g. polypharmacy was 39.0% in ID vs. 18.1% in non-ID cohort. Moreover, based on an analysis of the therapeutic groups and medications used that treatment was more intense in the ID cohort (95.8 vs. 7.0 International Non-proprietary Names per 100 participants. Supplement use was almost twice as prevalent in the ID group but substantially less diverse with only 10 types of supplements reported. Morbidity was higher in the ID group and showed a higher prevalence of neurological and mental health disorders.The results highlight that the burden of therapy management and the potential risks in those ageing with ID differs substantially from those ageing without ID. Understanding the medication and supplement use of people aging with intellectual disability (ID is critical to ensuring that health service providers in primary/ambulatory care can optimise use of these

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

Science.gov (United States)

Kapaale, Chaluza C

2018-03-01

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

Restrictive use of perioperative blood transfusion does not increase complication rates in microvascular breast reconstruction.

Science.gov (United States)

O'Neill, Anne C; Barandun, Marina; Cha, Jieun; Zhong, Toni; Hofer, Stefan O P

2016-08-01

With increasing appreciation of the possible adverse effects of peri-operative blood transfusion, restrictive policies regarding use of blood products have been adopted in many surgical specialties. Although microvascular breast reconstruction has become a routine procedure, high peri-operative transfusion rates continue to be reported in the literature. In this study we examine the impact of our restrictive approach on blood transfusion rates and postoperative complications in patients undergoing microvascular blood transfusion. A retrospective review of patients undergoing microvascular breast reconstruction with abdominal flaps at a single institution was performed. Patient age and body mass index as well as type, timing and laterality of reconstruction was recorded. Pre-operative and post-operative hemoglobin and hematocrit were recorded. Peri-operative blood transfusion rates were calculated. Post-operative complication rates were compared between patients with higher and lower post-operative hemoglobin levels. Five hundred and twelve patients were included in this study. The peri-operative transfusion rate was 0.98% in this series. There was no significant difference between transfusion rates in unilateral and bilateral reconstructions (0.68 vs 1.36% p = 0.08) or immediate and delayed reconstructions (1.02 vs 0.51% p = 0.72 and 1.01 vs 1.60% p = 0.09 for unilateral and bilateral respectively). Lower post-operative hemoglobin levels were not associated with increased flap related, surgical or medical complications rates. A restrictive approach to peri-operative blood transfusion can be safely adopted in microvascular breast reconstruction without compromising flap viability or overall complication rates. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A systematic review of peri-operative melatonin

DEFF Research Database (Denmark)

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

2014-01-01

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

The documentation of health problems in relation to prescribed medication in people with profound intellectual and multiple disabilities

NARCIS (Netherlands)

van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed.

Literature and disability: the medical interface in Borges and Beckett.

Science.gov (United States)

Novillo-Corvalán, Patricia

2011-06-01

Samuel Beckett and Jorge Luis Borges have presented 20th century literature with a distinctive gallery of solitary figures who suffer from a series of physiological ailments: invalidism, decrepitude, infirmity and blindness, as well as neurological conditions such as amnesia and autism spectrum disorders. Beckett and Borges were concerned with the dynamics between illness and creativity, the literary representation of physical and mental disabilities, the processes of remembering and forgetting, and the inevitability of death. This article explores the depiction of physically and mentally disabled characters in Borges' Funes the Memorious (1942)--a story about an Uruguayan gaucho who has been left paralysed after a fall from a horse which simultaneously endowed him with an infallible memory and perception--and Beckett's Trilogy: Molloy (1951), Malone Dies (1951) and The Unnamable (1953). It examines the prodigious memory of Funes and the forgetful minds of Molloy and Malone with reference to influential neuropsychological studies such as Alexander Luria's twofold exploration of memory and forgetfulness in The Mind of a Mnemonist (1968) and The Man with a Shattered World (1972). The article demonstrates that in contrast to Beckett's amnesiacs and Luria's brain-damaged patient, who are able to transcend their circumstances through cathartic writing, Borges' and Luria's mnemonic prodigies fail to achieve anything significant with their unlimited memories and remain imprisoned within their cognitive disabilities. It reveals that medical discourses can provide invaluable insights and lead to a deeper understanding of the minds and bodily afflictions of literary characters.

The role of personality, disability and physical activity in the development of medication-overuse headache

DEFF Research Database (Denmark)

Mose, Louise S; Pedersen, Susanne S; Debrabant, Birgit

2018-01-01

BACKGROUND: Factors associated with development of medication-overuse headache (MOH) in migraine patients are not fully understood, but with respect to prevention, the ability to predict the onset of MOH is clinically important. The aims were to examine if personality characteristics, disability...... and physical activity level are associated with the onset of MOH in a group of migraine patients and explore to which extend these factors combined can predict the onset of MOH. METHODS: The study was a single-center prospective observational study of migraine patients. At inclusion, all patients completed...... questionnaires evaluating 1) personality (NEO Five-Factor Inventory), 2) disability (Migraine Disability Assessment), and 3) physical activity level (Physical Activity Scale 2.1). Diagnostic codes from patients' electronic health records confirmed if they had developed MOH during the study period of 20 months...

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

International Nuclear Information System (INIS)

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

2015-01-01

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

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

Science.gov (United States)

Karlsen, Ero S; Toussaint, Pieter Jelle

2010-01-01

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

Physical practice is associated with less functional disability in medical students with migraine

Directory of Open Access Journals (Sweden)

Renan B. Domingues

2011-02-01

Full Text Available The aim of this study was to investigate possible association between migraine and physical practice among 480 medical students who were submitted to a questionnaire about headaches and physical practices. Migraine diagnosis was assessed by ID-Migraine and functional disability was evaluated with MIDAS. The type (aerobic or strength training, the weekly frequency and the intensity of physical practice and body mass index (BMI were assessed. There was a reduction in functional disability of migraine in students reporting physical practice (no physical practice - MIDAS=8.81±1.40, physical practice - MIDAS=15.49±1.78; P=0.03. Frequency, intensity, and type of physical practices were not associated with functional impact of migraine. BMI did not correlate with migraine impact (normal weight - MIDAS=12.34±1.33, overweight or obese - MIDAS=17.45±3.86; P=0.33. These results were confirmed by multivariate analysis. Our data suggest that physical practice is inversely related with functional disability of migraine in university students regardless of BMI.

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period.

Science.gov (United States)

Demsey, Daniel; Carr, Nicholas J; Clarke, Hance; Vipler, Sharon

2017-10-01

Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons' prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.

Ethics in perioperative practice--patient advocacy.

Science.gov (United States)

Schroeter, Kathryn

2002-05-01

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

Enacting Disability: How Can Science and Technology Studies Inform Disability Studies?

Science.gov (United States)

Galis, Vasilis

2011-01-01

This paper aims to discuss how science and technology studies (STS) can inform disability studies and challenge dominant approaches, such as the medical and the social models, in the ordering and representation of disability. Disability studies and STS have followed somewhat parallel paths in the history of ideas. From a positivist approach to…

Transitioning From Perioperative Staff Nurse to Perioperative Educator.

Science.gov (United States)

Mower, Juliana

2017-08-01

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

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

Science.gov (United States)

Taylor, David L

2014-07-01

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

Critical Elements for the Pediatric Perioperative Anesthesia Environment.

Science.gov (United States)

Polaner, David M; Houck, Constance S

2015-12-01

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

Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002).

Science.gov (United States)

Gibson, Thomas W G; Brisson, Brigitte A; Sears, William

2005-07-01

To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. Retrospective study. 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

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

DEFF Research Database (Denmark)

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

2018-01-01

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

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

African Journals Online (AJOL)

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

Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

International Nuclear Information System (INIS)

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

2010-01-01

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

Influence of Age, Gender, and Living Circumstances on Patterns of Attention-Deficit/Hyperactivity Disorder Medication Use in Children and Adolescents With or Without Intellectual Disabilities.

Science.gov (United States)

Osunsanmi, Sunkanmi; Turk, Jeremy

2016-11-01

The aim of the study was to determine whether there are differences in psychopharmacological practice for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents dependent on the presence or absence of associated intellectual disability; and if there are, whether the differences are influenced by factors such as age, gender, and living circumstances. A case-control cross-sectional design was used. Each arm of the study had a total of 107 children and adolescents aged 5-18 years. Case participants had diagnoses of having intellectual disability and ADHD; comparison participants had diagnoses of having ADHD, but no intellectual disability. Outcome measurements were (1) concurrent use of medications-single medication event as against concurrent multiple medication events-and (2) type of medication used-stimulants versus nonstimulants. Demographic factors considered were gender, age, and living circumstances. Male-to-female ratio in each group was 90:17. Mean age in the case group was 10.93 years (standard deviation [SD]: 3.39 years) and in the comparison group, 12.34 years (SD: 3.22 years). Seventy percent of the case group lived with their biological families, while 84% of the comparison group did so. In the case group, 7.5% were in residential school placements compared with only 0.9% of the comparison group. There were no statistically significant differences in broad measurements of outcomes between the case and comparison groups. Age appeared to be an important moderating factor for type of medication prescribed. Younger children with intellectual disabilities and ADHD were more likely to be established on nonstimulant medications than those with ADHD and no intellectual disabilities (p = 0.024, odds ratio: 1.8; 95% CI: 1.2-2.7). Being between the ages of 5 and 12 years and having intellectual disability and ADHD are associated with raised likelihood of being prescribed nonstimulant medications for ADHD. This difference is maintained

[Temporary disability and its legal implications].

Science.gov (United States)

Martin-Fumadó, Carles; Martí Amengual, Gabriel; Puig Bausili, Lluïsa; Arimany-Manso, Josep

2014-03-01

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers' temporary disability to their company's medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflict. Copyright © 2014 Elsevier España, S.L. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Gattis Katherine G

2009-08-01

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

Old, new and hidden causes of perioperative hypersensitivity

DEFF Research Database (Denmark)

Garvey, Lene Heise

2016-01-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2018-02-20

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

Facing up to disability

OpenAIRE

Tom Shakespeare

2013-01-01

Ways of thinking about and responding to disability have radically changed in recent decades. Traditionally, disability was regarded in terms of sin, karma, or divine punishment. More recently, disability was made a medical issue and defined in terms of shortcomings of body or mind, which had to be prevented or cured at all costs. In the late 20th century, people with disabilities worldwide became more organised and created national and international disabled people’s organisations. They succ...

Total hip and knee joint replacement: perioperative clinical aspects

Directory of Open Access Journals (Sweden)

Luciana Pereira Almeida de Piano

2010-09-01

Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

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

Science.gov (United States)

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

2018-01-01

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

Perioperative nurses' attitudes toward the electronic health record.

Science.gov (United States)

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

2015-02-01

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

Is Disability a Health Problem?

Directory of Open Access Journals (Sweden)

Malcolm MacLachlan

2013-12-01

Full Text Available We welcome Andrew Haig's critique of our paper, "Disability & Health: A research agenda" in Social Inclusion. Our paper sought to identify research priorities to better understand, provide enhanced services and a better quality of life for people with disabilities, particularly in relation to their health and wellbeing. Haig's critique makes several important points that deserve serious consideration. His comments reflect a view of the relationship between disability and health which is different from the one we have espoused. Specifically, Haig argues that (a disability is a health problem, (b medical rehabilitation should be separated from Community Based Rehabilitation (CBR, and (c the evidence base for medical rehabilitation is much stronger than for CBR. We address each of these points below arguing that while some types of disability clearly result from health problems; often disability is not experienced as a health problem; and sometimes, disability in interaction with restricted access is the cause of health problems.

Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians

NARCIS (Netherlands)

van Rijssen, H.J.; Schellart, A.J.M.; Berkhof, M.; Anema, J.R.; van der Beek, A.J.

2010-01-01

Background: Physicians who hold medical disability assessment interviews (social insurance physicians) are probably influenced by stereotypes of claimants, especially because they have limited time available and they have to make complicated decisions. Because little is known about the influences of

Perioperative corticosteroids for intermittent and mild persistent asthma

OpenAIRE

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

2002-01-01

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

Hip Resurfacing Arthroplasty and Perioperative Blood Testing

Directory of Open Access Journals (Sweden)

Andrew Cook

2014-01-01

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

Nutrition in peri-operative esophageal cancer management.

Science.gov (United States)

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

2017-07-01

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

Medication Use among Australian Adults with Intellectual Disability in Primary Healthcare Settings: A Cross-Sectional Study

Science.gov (United States)

Doan, Tan N.; Lennox, Nicholas G.; Taylor-Gomez, Miriam; Ware, Robert S.

2013-01-01

Background: There is concern about widespread medication use by people with intellectual disability (ID), especially psychotropic and anticonvulsant agents. However, there is sparse information on prescribing patterns in Australia. Method: This cross-sectional study was conducted between 2000 and 2002 among adults with ID who live in the community…

Reporting about disability evaluation in European countries.

Science.gov (United States)

Anner, Jessica; Kunz, Regina; Boer, Wout de

2014-01-01

To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant's working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant's health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research. Implications for Rehabilitation Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability. Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured

Peri-operative care.

Science.gov (United States)

Baston, Helen

2004-05-01

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

Validation of the TRUST tool in a Greek perioperative setting.

Science.gov (United States)

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

2017-06-01

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

Clean Surgical Perioperative Prophylaxis Analysis%428例清洁手术围手术期预防用药分析

Institute of Scientific and Technical Information of China (English)

陈莉; 曾文谊

2012-01-01

目的 探讨Ⅰ类切口手术患者围手术期预防应用抗菌药物的合理性.方法 回顾性调查医院2010年1月至9月,围手术期预防感染病历428份,对清洁手术围手术期抗菌药物应用进行合理性分析.结果 428份病历中,抗菌药物使用率过高,达92.52％；给药时机不规范;术后用药时间过长；药物选择起点过高；不符合用药经济学原则.结论 清洁手术围手术期预防感染抗茵药物使用,仍存在较多问题,应加强规范管理.%Objective To investigate the rationality of class I incision surgery to prevent perioperative application of antibiotics. Methods A retrospective survey in our hospital from January to September 2010 perioperative prevention of infection in 428 medical records, for clean surgical perioperative antimicrobial agents for rational analysis. Results Four hundred and twenty eight copies of medical records results in excessive usage of antibiotics, up to 92. 52% ; delivery time is not standardized; postoperative medication for too long; drug of choice for the starting point is too high; medication does not meet the principles of economics. Conclusion Clean surgical hospital pen-operative use of antibiotics to prevent infection,there are still more problems,should strengthen its regulation and management.

Tranexamic Acid: From Trauma to Routine Perioperative Use

Science.gov (United States)

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

2015-01-01

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

In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration

NARCIS (Netherlands)

Blom, M T; de Jonghe, A; van Munster, B C; de Rooij, S E; Tan, H L; van der Velde, Nathalie; Jansen, S.

2015-01-01

OBJECTIVES: Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated

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

Science.gov (United States)

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

2017-12-01

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

Detrimental effects of perioperative blood transfusion

DEFF Research Database (Denmark)

Nielsen, Hans Jørgen

1995-01-01

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

Vasopressin in perioperative management of congenital ...

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2017-01-01

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

[Perioperative managment of laparoscopic sleeve gastrectomy].

Science.gov (United States)

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

2013-10-01

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

The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.

Science.gov (United States)

Alcock, Richard F; Naoum, Chris; Aliprandi-Costa, Bernadette; Hillis, Graham S; Brieger, David B

2013-07-31

Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised. The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed. We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk. Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management. Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

Laustsen, Gary

2007-04-01

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

A Novel Process Audit for Standardized Perioperative Handoff Protocols.

Science.gov (United States)

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

2017-11-01

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

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

Science.gov (United States)

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

2017-07-01

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

Concurrent Medical Conditions and Health Care Use and Needs among Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey, 2006-2010

Science.gov (United States)

Schieve, Laura A.; Gonzalez, Vanessa; Boulet, Sheree L.; Visser, Susanna N.; Rice, Catherine E.; Braun, Kim Van Naarden; Boyle, Coleen A.

2012-01-01

Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a…

Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment

DEFF Research Database (Denmark)

Bendtsen, L; Munksgaard, Sb; Tassorelli, C

2014-01-01

OBJECTIVE: The objective of this article is to investigate whether headache-related disability, depression and anxiety can be reduced by detoxification and prophylactic treatment in patients with medication-overuse headache (MOH). METHODS: Patients with MOH were included from six centres in Europ...

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

Science.gov (United States)

Rudolfsson, Gudrun

2014-08-01

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

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

Science.gov (United States)

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

2010-09-01

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

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

Science.gov (United States)

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

2017-12-14

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

Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

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Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M

2014-12-01

To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities. Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008. We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening. We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18-64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest. Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs. There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups. © Health Research and Educational Trust.

The Use of Psychotropic Medication for People with Intellectual Disabilities and Behaviours That Challenge in the Context of a Community Multidisciplinary Team Approach

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Niven, Abigail; Goodey, Rebecca; Webb, Alison; Shankar, Rohit

2018-01-01

Background: The use of psychotropic medication to manage challenging behaviours of people with intellectual disabilities is a contentious issue which NHS England has now focused on. This paper looks to evaluate this within the multidisciplinary context. Method: Records of clients (n = 106) open to a Community Intellectual Disabilities team for…

The role of perioperative warming in surgery: a systematic review

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Muhammad Shafique Sajid

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

[From disability to the adunatos: some thoughts on disability and somatoform pain disorder].

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Delli Noci, C; Barras, V; Stiefel, F

2013-02-13

Disability, especially if related to a psychiatric disorder, such as somatoform pain disorder, is characterized by medical, psychological, relational, social and societal, as well as financial and political aspects. This manuscript, part of a PhD thesis which reflects on a possible dialogue between an ancient text and the modern conceptualization of disability, tries to address the phenomenological, historical and political dimensions of disability.

Disability in a Human Rights Context

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Theresia Degener

2016-08-01

Full Text Available The Convention on the Rights of Persons with Disabilities (CRPD is a modern human rights treaty with innovative components. It impacts on disability studies as well as human rights law. Two innovations are scrutinized in this article: the model of disability and the equality and discrimination concepts of the CRPD. It is argued that the CRPD manifests a shift from the medical model to the human rights model of disability. Six propositions are offered why and how the human rights model differs from the social model of disability. It is further maintained that the CRPD introduces a new definition of discrimination into international public law. The underlying equality concept can be categorized as transformative equality with both individual and group oriented components. The applied methodology of this research is legal doctrinal analysis and disability studies model analysis. The main finding is that the human rights model of disability improves the social model of disability. Three different models of disability can be attributed to different concepts of equality. The medical model corresponds with formal equality, while the social model with substantive equality and the human rights model can be linked with transformative equality.

Effect of perioperative insulin infusion on surgical morbidity and mortality

DEFF Research Database (Denmark)

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

2008-01-01

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

Bad Bedfellows: Disability Sex Rights and Viagra

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Wentzell, Emily

2006-01-01

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of non-normative erections as…

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

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

2002-01-01

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

Issues in the Medication Management Process in People Who Have Intellectual and Developmental Disabilities: A Qualitative Study of the Caregivers' Perspective

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Erickson, Steven R.; Salgado, Teresa M.; Tian, Xi

2016-01-01

People who have intellectual and developmental disabilities (IDD) often rely on caregivers to assist in the medication management process. The aim of this study was to learn from caregivers, who are either family or support staff, what major issues arise throughout the process of managing medication and how these might be addressed. Problems…

Optimizing Perioperative Nutrition in Pediatric Populations.

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

2016-02-01

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

Perioperative Management of Diabetes: A Review

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Md Nazmul Kayes

2014-07-01

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

THE MEDICAL AND SOCIAL MODELS OF DISABILITY FROM THE MEANINGS OF SEGREGATION AND INCLUSION IN MICHEL FOUCAULT’S AND MARTHA NUSSBAUM’S DISCOURSES

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Ana Paula Barbosa-Fohrmann

2017-02-01

Full Text Available First, this paper will approach the meanings of segregation (or exclusion, integration and inclusion grounded on the interpretation of several provisions of key international documents. Secondly, it intends to overcome the legal analysis and examine Michel Foucault’s and Martha Nussbaum’s discourses on disabilities. Michel Foucault, by means of a historical criticism, focuses his analysis on the medical model of segregation (or exclusion while Martha Nussbaum proposes a social model that intends to be more inclusive of persons with disabilities. The medical model of integration will not be tackled in this paper.

The medical reshaping of disabled bodies as a response to stigma and a route to normality.

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McLaughlin, Janice

2017-12-01

Disabled people are said to experience stigma because their embodied presence in the world does not fit with how others interact and use their bodies to be social participants. In response they can turn to medical procedures, such as surgery or physiotherapy, in order to reshape their bodies to more closely approximate norms of social interaction and embodiment. This paper explores how medicine plays a role in attempts to be recognised by others as normal and acceptable by minimising disability. It will do so via a focus on disabled young people, in order to explore how their emerging identities and aspirations for the future influence how they think about their bodies, what normality means and their participation in multiple activities that work on their bodies. The paper draws from an Economic and Social Research Council (ESRC) project that used a range of qualitative research methods with a group of disabled young people. The project explored ways in which participants actively worked on their bodies to be more normal and examined the disciplinary and agency dynamics involved in this work. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Rhinoplasty perioperative database using a personal digital assistant.

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Kotler, Howard S

2004-01-01

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

Perioperative Rosuvastatin in Cardiac Surgery.

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

2016-05-05

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

Perioperative blood loss and diclofenac in major arthroplastic surgery

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Ljiljana Gvozdenović

2011-04-01

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

Facing up to disability

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Tom Shakespeare

2013-05-01

Full Text Available Ways of thinking about and responding to disability have radically changed in recent decades. Traditionally, disability was regarded in terms of sin, karma, or divine punishment. More recently, disability was made a medical issue and defined in terms of shortcomings of body or mind, which had to be prevented or cured at all costs. In the late 20th century, people with disabilities worldwide became more organised and created national and international disabled people’s organisations. They successfully demanded that disability be seen as a matter of equal opportunities and human rights, a shift which has now been described in the United Nations Convention on the Rights of Persons with Disabilities. This is a global treaty which has so far been signed by 155 states and passed into law by 127.

Disability Evaluation System Analysis and Research Annual Report 2015

Science.gov (United States)

2016-03-11

Inclusion of laboratory and diagnostic information on the medical condition or injury that precipitated the disability evaluation in each service’s...Annual Report 2015 Disability Evaluation Systems Analysis and Research Prepared by Accession Medical Standards Analysis and Research Activity...Preventive Medicine Branch Walter Reed Army Institute of Research Silver Spring, Maryland Disability Evaluation Systems Analysis and Research

Perioperative Management of a Patient with Cold Urticaria

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Priscilla Agbenyefia

2017-12-01

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

Perceived images of disability: the reflections of two undergraduate medical students in a university in South Africa on life in a wheelchair.

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Amosun, Seyi L; Volmink, Lauren; Rosin, Rainer

2005-08-19

The purpose of this manuscript is to document the experiences of two undergraduate medical students at the University of Cape Town, South Africa, who registered for a 4-week special study module titled "Images of Disability", as part of the medical training programme. The objective of the module was to foster the development of positive attitudes toward persons with physical disability through role-playing. The special study module required that the students assumed they had mobility impairments and were physically confined to wheelchairs. The students were required to document their personal experiences of life in a wheelchair for five consecutive working days. The students had to deal with their perceptions of the attitudes of individuals they interacted with, which resulted in feeling of inferiority and lowered self-esteem. The students also identified obstacles in the environment which hindered integration. The students reported significant positive changes in their attitudes towards persons with disabilities.

Importance of Perioperative Glycemic Control in General Surgery

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

2014-01-01

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

Perioperative risk factors for hospital readmission after elective endovascular aortic aneurysm repair.

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Chen, Samuel L; Kuo, Isabella J; Kabutey, Nii-Kabu; Gabra, Fady; Fujitani, Roy M

2018-04-02

Elective endovascular aneurysm repair (EVAR) is generally well tolerated. However, the incidence of hospital readmission after EVAR and the risk factors and reasons for it are not well studied. This study sought to determine the incidence, to characterize the indications, and to identify perioperative patient-centered risk factors for hospital readmission within 30 days after elective EVAR. All patients who underwent EVAR electively in 2012 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program Targeted Vascular database (n = 3886). Preoperative demographics, operation-specific variables, and postoperative outcomes were compared between those who were readmitted within 30 days of the index operation and those who were not. Multivariate logistic regression was then used to determine independent predictors of hospital readmission. The unadjusted 30-day readmission rate after EVAR was 8.2%. Of all readmissions, 55% were for reasons related to the procedure. Median time to readmission was 12 days. Significant preoperative risk factors associated with readmission were female sex, preoperative steroid use, congestive heart failure, and dialysis dependence (P readmission, including myocardial infarction and deep venous thrombosis (P readmission were surgical site infection (odds ratio, 10.24; 95% confidence interval, 5.31-19.75; P readmissions remain a costly problem after vascular surgery and are associated with 30-day mortality after elective EVAR. Whereas female sex and certain irreversible medical comorbidities are nonmodifiable, focusing on medical optimization and identifying those perioperative variables that can affect the need for post-EVAR interventions will be an important step in decreasing hospital readmission. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

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Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

2017-06-30

'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

Model of Intellectual Disability and the Relationship of Attitudes Towards the Sexuality of Persons with an Intellectual Disability.

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Parchomiuk, Monika

2013-06-01

The following article discusses the relationship between the model of intellectual disability and the attitudes towards sexuality of people with disabilities. This correlation has been verified during the author's own research conducted on students of several medical faculties such as nursing, public health, emergency medical services and physiotherapy. Tools of the author's design have been used in the research. Likert-type scale "Perspective of intellectual disability" has been used to determine the model of disability seen from the medical (individual) or social perspective. To examine the attitudes towards sexuality two tools of the author's own design have been used: a Likert-type scale "The essence of sexuality in persons with an intellectual disability" which has been used to analyze the cognitive aspect of the attitudes, and a semantic differential with notions concerning physical and psychosocial aspects of sexuality including the affective-evaluative aspect. As expected, significant correlations have been found between the model and the attitudes both in the cognitive and the affective-evaluative aspect. Higher scores for the individual model correlated with: (a) lover scores for most aspects of sexuality of people with intellectual disability, (b) perceiving them as asexual, (c) biological determinism in the sexual sphere. The social model concurred with positive values given to sexuality of people with intellectual disability and its normalization in the sphere of its determinants and symptoms.

Perioperative feedback in surgical training: A systematic review.

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

2017-07-01

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

Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

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Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

2014-03-01

Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

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

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

2015-12-01

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

[The standardized perioperative treatment of chronic rhinosinusitis with nasal polyps and asthma].

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Li, Tingting; Ju, Jianbao; Yu, Hailing; Xie, Daoyu

2015-04-01

To discuss the perioperative treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Retrospective analysis of perioperative clinical data of 43 cases with CRSwNP and asthma. The admitted and under endoscopic surgery. Patients with preventing perioperative asthma attacks and corresponding standardized treatment were Observed. Thirty-five cases were stable during perioperative period and without asthma. Seven patients diagnosed as mild and moderate asthma attacks because of low pulse oximetry (SpO2 92%-95%) and scattered wheeze heard in the lungs. So these patients were sent to ICU for the treatment. They went back to ward after their conditions turned to stable and no asthma during perioperative. One patient diagnosed as severe asthma attack, because irritability and suffocation happened, SpO2 decreased from 99% to 84%-81%, diffuse wheeze could be heard in the whole lung . So we give him tracheal intubation and sent him to ICU for advanced treatment after breathing smooth. Five days later the patient retuned to the ward in stable condition and with no asthma attack again. Before operation the patients should be give some corresponding standardized comprehensive treatment according to the nasal symptoms and the degree of asthma attack, such as the application of topical steroid and antiallergic medicine. And some special treatment should be given to reduce airway hyperresponsiveness mucosa during anesthesia. These methods can reduce the risk of the asthma attacks and improve perioperative safety, prevent serious complications.

Negotiating hearing disability and hearing disabled identities

DEFF Research Database (Denmark)

Lykke Hindhede, Anette

2012-01-01

  　 Using disability theory as a framework and social science theories of identity to strengthen the arguments, this paper explores empirically how working-age adults confront the medical diagnosis of hearing impairment. For most participants hearing impairment threatens the stability of social...... interaction and the construction of hearing disabled identities is seen as shaped in the interaction with the hearing impaired person‟s surroundings. In order to overcome the potential stigmatisation the „passing‟ as normal becomes predominant. For many the diagnosis provokes radical redefinitions of the self....... The discursively produced categorisation and subjectivity of senescence mean that rehabilitation technologies such as hearing aids identify a particular life-style (disabled) which determines their social significance. Thus wearing a hearing aid works against the contemporary attempt to create socially ideal...

Physical disability contributes to caregiver stress in dementia caregivers.

Science.gov (United States)

Bruce, David G; Paley, Glenys A; Nichols, Pamela; Roberts, David; Underwood, Peter J; Schaper, Frank

2005-03-01

Previous findings of studies on the impact of physical illness on caregiver health have been inconsistent. The authors wanted to determine whether physical disability, as determined by the SF-12 survey that provides information on both physical and mental health problems, contributes to caregiver stress. The authors interviewed 91 primary caregivers (aged 38-85 years) of persons with dementia who had been referred by their family physicians for the first time for formal support services or memory evaluation. Caregivers completed the SF-12 version of the Medical Outcomes Study Short Form Health Survey that generates Mental Component Summary (MCS) and Physical Component Summary (PCS) scores and reported on caregiver stress and concurrent medical conditions and medications. Most caregivers reported stress (76.9%), having medical conditions (72.4%), or taking medications (67%). The MCS but not the PCS scores were significantly lower than community norms, indicating an excess of disability due to mental health problems. Nevertheless, 40.7% had PCS scores indicating some degree of physical disability. Using multiple logistic regression analysis, PCS scores but not the presence of medical problems were independently associated with caregiver stress. Chronic disability as assessed by SF-12 PCS scores is independently associated with caregiver stress. These data suggest that caregivers of persons with dementia should be assessed for disabling physical conditions and mental health problems. In addition, reducing the impact of physical disability could ameliorate caregiver stress.

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

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Ehab A. Wahby

2016-08-01

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

Learning from lives together: medical and social work students' experiences of learning from people with disabilities in the community.

Science.gov (United States)

Anderson, E S; Smith, R; Thorpe, L N

2010-05-01

The study aims to evaluate an interprofessional community-based learning event, focussing on disability. The learning opportunity was based on the Leicester Model of Interprofessional Education, organised around the experiences and perceptions of service users and their carers. Programme participants were drawn from medicine and social work education in Leicester, UK, bringing together diverse traditions in the care of people with disabilities. Small student groups (3-4 students) worked from one of the eight community rehabilitation hospitals through a programme of contact with people with disabilities in hospital, at home or in other community settings. The evaluation, in March 2005, used a mixed methods approach, incorporating questionnaire surveys, focus group interviews with students and feedback from service users. Responses were collated and analysed using quantitative and qualitative measures. Fifty social work and 100 medical students completed the first combined delivery of the module. The findings indicated that the merging of social work and medical perspectives appear to create some tensions, although overall the student experience was found to be beneficial. Service users (16 responses) valued the process. They were not concerned at the prospect of meeting a number of students at home or elsewhere and were pleased to think of themselves as educators. Problems and obstacles still anticipated include changing the mindset of clinicians and practising social workers to enable them to support students from each other's disciplines in practice learning. The generally positive outcomes highlight that disability focussed joint learning offers a meaningful platform for interprofessional education in a practice environment.

[Work disability in public press professions].

Science.gov (United States)

Akermann, S

2002-09-01

In this study more than 1,000 cases of long-term disability among members of the press and media were evaluated. Mental disorders were the main cause of disability in almost every fourth case. In women psychiatric illnesses were even more important. The most common diagnosis was that of a depressive disorder which accounted for more than half of all psychiatric cases. The causes of disability of other insurance systems such as the German social security scheme and the pension and disability plan for the medical profession were compared. Mental illnesses are the leading cause of disability in white collar workers and orthopaedic illnesses, especially disorders of the vertebral column, are the leading cause in blue collar workers, as one might have expected. In females mental disorders are even more common than in men whereas men tend to have more cardiovascular problems than women. In this study also some interesting features regarding disability caused by various illnesses after long-term follow-up were found. This opens unknown perspectives allowing new assessment of diseases and eventually will enable the actuary to price medical diagnoses for disability insurance.

Comparative analysis of perioperative complications between a multicenter prospective cervical deformity database and the Nationwide Inpatient Sample database.

Science.gov (United States)

Passias, Peter G; Horn, Samantha R; Jalai, Cyrus M; Poorman, Gregory; Bono, Olivia J; Ramchandran, Subaraman; Smith, Justin S; Scheer, Justin K; Sciubba, Daniel M; Hamilton, D Kojo; Mundis, Gregory; Oh, Cheongeun; Klineberg, Eric O; Lafage, Virginie; Shaffrey, Christopher I; Ames, Christopher P

2017-11-01

Complication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases. To compare perioperative complication rates following adult cervical deformity corrective surgery between a prospective multicenter database for patients with cervical deformity (PCD) and the Nationwide Inpatient Sample (NIS). Retrospective review of prospective databases. A total of 11,501 adult patients with cervical deformity (11,379 patients from the NIS and 122 patients from the PCD database). Perioperative medical and surgical complications. The NIS was queried (2001-2013) for cervical deformity discharges for patients ≥18 years undergoing cervical fusions using International Classification of Disease, Ninth Revision (ICD-9) coding. Patients ≥18 years from the PCD database (2013-2015) were selected. Equivalent complications were identified and rates were compared. Bonferroni correction (pdatabases. A total of 11,379 patients from the NIS database and 122 patiens from the PCD database were identified. Patients from the PCD database were older (62.49 vs. 55.15, pdatabase. The PCD database had an increased risk of reporting overall complications than the NIS (odds ratio: 2.81, confidence interval: 1.81-4.38). Only device-related complications were greater in the NIS (7.1% vs. 1.1%, p=.007). Patients from the PCD database displayed higher rates of the following complications: peripheral vascular (0.8% vs. 0.1%, p=.001), gastrointestinal (GI) (2.5% vs. 0.2%, pdatabases (p>.004). Based on surgicalapproach, the PCD reported higher GI and neurologic complication rates for combined anterior-posterior procedures (pdatabase revealed higher overall and individual complication rates and higher data granularity. The nationwide database may underestimate complications of patients with adult cervical deformity (ACD) particularly in regard to perioperative surgical details owing to coding and deformity generalizations. The surgeon-maintained database

Intravenous sub-anesthetic ketamine for perioperative analgesia

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Andrew W Gorlin

2016-01-01

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

Assessment of ADHD Documentation from Candidates Requesting Americans with Disabilities Act (ADA) Accommodations for the National Board of Osteopathic Medical Examiners COMLEX Exam

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Joy, Javed A.; Julius, Rose J.; Akter, Rashida; Baron, David A.

2010-01-01

Purpose: Every year increasing numbers of candidates request special accommodations for high-stakes medical licensing examinations, due to ADHD, on the basis of the Americans with Disabilities Act (ADA). This poses significant challenges for both the applicant and the medical boards and has significant financial, legal, and ethical implications.…

anaesthetic registrars' experiences of perioperative death

African Journals Online (AJOL)

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

Perioperative management of patient with alkaptonuria and associated multiple comorbidities

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Ravindra Pandey

2011-01-01

Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

Burnout in perioperative context

OpenAIRE

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

2014-01-01

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

Work Ability Index predicts application for disability pension after work-related medical rehabilitation for chronic back pain.

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Bethge, Matthias; Gutenbrunner, Christoph; Neuderth, Silke

2013-11-01

To determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation. Cohort study with 3-month follow-up. Seven inpatient rehabilitation centers. Patients (N=294; 168 women; mean age, 49.9y) with chronic back pain. The WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation. Application for disability pension, as assessed by a postal questionnaire 3 months after discharge. Receiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62-.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6-68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5-16.8) higher odds of unemployment, and 6 times (95% CI, 2.4-15.2) higher odds of long-term sick leave at follow-up. The WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

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Hawkes Eliza A

2012-08-01

Full Text Available Abstract Background Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC. Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Methods Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Results Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS and those who underwent surgery alone (S respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Conclusions Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

Perioperative pharmacokinetics of methadone in adolescents.

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

2011-12-01

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

Workplace Discrimination and the Perception of Disability

Science.gov (United States)

Draper, William R.; Reid, Christine A.; McMahon, Brian T.

2011-01-01

This article documents the employment discrimination experienced by Americans "regarded as" disabled (but not medically verified as such), using the Integrated Mission System of the U.S. Equal Employment Opportunity Commission (EEOC). Claimants who were perceived as disabled, as contrasted with those with documented disabilities, were more likely…

PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

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V. N. Amirdzhanova

2014-01-01

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

Medication errors in anesthesia: unacceptable or unavoidable?

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Ira Dhawan

Full Text Available Abstract Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to ‘treat' drug errors is to prevent them. Wrong medication (due to syringe swap, overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error, incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and ‘just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.

Patient Education May Improve Perioperative Safety.

NARCIS (Netherlands)

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

2016-01-01

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

Perioperative care of the older patient

NARCIS (Netherlands)

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

2011-01-01

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

Vasopressin in perioperative management of congenital ...

African Journals Online (AJOL)

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

Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain: Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A Review of the Literature.

Science.gov (United States)

Gaudin, Daniel; Krafcik, Brianna M; Mansour, Tarek R; Alnemari, Ahmed

2017-02-01

Despite widespread use of lumbar spinal fusion as a treatment for back pain, outcomes remain variable. Optimizing patient selection can help to reduce adverse outcomes. This literature review was conducted to better understand factors associated with optimal postoperative results after lumbar spinal fusion for chronic back pain and current tools used for evaluation. The PubMed database was searched for clinical trials related to psychosocial determinants of outcome after lumbar spinal fusion surgery; evaluation of commonly used patient subjective outcome measures; and perioperative cognitive, behavioral, and educational therapies. Reference lists of included studies were also searched by hand for additional studies meeting inclusion and exclusion criteria. Patients' perception of good health before surgery and low cardiovascular comorbidity predict improved postoperative physical functional capacity and greater patient satisfaction. Depression, tobacco use, and litigation predict poorer outcomes after lumbar fusion. Incorporation of cognitive-behavioral therapy perioperatively can address these psychosocial risk factors and improve outcomes. The 36-Item Short Form Health Survey, European Quality of Life five dimensions questionnaire, visual analog pain scale, brief pain inventory, and Oswestry Disability Index can provide specific feedback to track patient progress and are important to understand when evaluating the current literature. This review summarizes current information and explains commonly used assessment tools to guide clinicians in decision making when caring for patients with lower back pain. When determining a treatment algorithm, physicians must consider predictive psychosocial factors. Use of perioperative cognitive-behavioral therapy and patient education can improve outcomes after lumbar spinal fusion. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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Gabriel Rodrigues

2013-01-01

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

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

Science.gov (United States)

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

2015-10-01

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

Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial.

Science.gov (United States)

McIlroy, David; Murphy, Deirdre; Kasza, Jessica; Bhatia, Dhiraj; Wutzlhofer, Lisa; Marasco, Silvana

2017-06-01

The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. The perioperative protocol governed all fluid administration from commencement of anesthesia through to discharge from the intensive care unit and varied over four sequential periods, each lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a chloride-limited strategy, consisting of a buffered salt solution and 20% albumin, was used. Co-primary outcomes were peak delta serum creatinine (∆S Cr ) within 5 days after the operation and KDIGO-defined stage 2 or stage 3 acute kidney injury (AKI) within 5 days after the operation. We enrolled and analysed data from 1136 patients, with 569 patients assigned to a chloride-rich fluid strategy and 567 to a chloride-limited one. Compared with a chloride-limited strategy and adjusted for prespecified covariates, there was no association between a chloride-rich perioperative fluid strategy and either peak ∆S Cr , transformed to satisfy the assumptions of multivariable linear regression [regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08); p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI 0.65-1.47; p = 0.90]. A perioperative fluid strategy to restrict IV chloride administration was not associated with an altered incidence of AKI or other metrics of renal injury in adult patients undergoing cardiac surgery. Clinicaltrials.gov Identifier: NCT02020538.

The Effect of an Intervention Aimed at Reducing Errors when Administering Medication through Enteral Feeding Tubes in an Institution for Individuals with Intellectual Disability

Science.gov (United States)

Idzinga, J. C.; de Jong, A. L.; van den Bemt, P. M. L. A.

2009-01-01

Background: Previous studies, both in hospitals and in institutions for clients with an intellectual disability (ID), have shown that medication errors at the administration stage are frequent, especially when medication has to be administered through an enteral feeding tube. In hospitals a specially designed intervention programme has proven to…

Clinical performance feedback and quality improvement opportunities for perioperative physicians

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Kaye AD

2014-05-01

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

Using YouTube in perioperative nursing education.

Science.gov (United States)

Logan, Rebecca

2012-04-01

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

Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy?

Science.gov (United States)

Khene, Zine-Eddine; Peyronnet, Benoit; Bosquet, Elise; Pradère, Benjamin; Robert, Corentin; Fardoun, Tarek; Kammerer-Jacquet, Solène-Florence; Verhoest, Grégory; Rioux-Leclercq, Nathalie; Mathieu, Romain; Bensalah, Karim

2017-10-01

To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time Training fellows to perform RAPN is associated with longer operating time and WIT but does not appear to compromise other peri-operative outcomes. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

A protocol for a systematic review for perioperative pregabalin use

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Eipe Naveen

2012-09-01

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

Introduction: Childhood and Disability.

Science.gov (United States)

Salter, Erica K

2017-09-01

From growth attenuation therapy for severely developmentally disabled children to the post-natal management of infants with trisomy 13 and 18, pediatric treatment decisions regularly involve assessments of the probability and severity of a child's disability. Because these decisions are almost always made by surrogate decision-makers (parents and caregivers) and because these decision-makers must often make decisions based on both prognostic guesses and potentially biased quality of life judgments, they are among the most ethically complex in pediatric care. As the introduction to HEC Forum's special thematic issue on Childhood and Disability, this article orients the reader to the history of bioethics' relationship to both pediatric ethics and disability studies and introduces the issue's five manuscripts. As clinicians, disability scholars, philosophers and clinical ethicists writing on various aspects of pediatric disability, the articles' authors all invite readers to dig beneath an overly-simplified version of what disability might mean to children and families and instead embrace a posture of genuine humility, recognizing both the limits and harms of traditional medical and bioethical responses (or indifferences) to the disabled child.

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

Science.gov (United States)

Landreneau, Raphael

2010-12-01

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

[The burden of disability in Cameroon].

Science.gov (United States)

Foti, Calogero; Albensi, Caterina; Giordani, Laura; Azeufack Ngueko, Yannick; Sanou Sobze, Martin; Colizzi, Vittorio

2017-01-01

Rehabilitation services for disabled persons are lacking in countries with limited economic resources. Reliable and objective data are needed to plan for their implementation and to determine the burden of disability in these countries. A descriptive cross-sectional study conducted in June 2013 among people living in Dschang Health District, in the West region of Cameroon, to collect information about socio-demographic aspects of physically disabled subjects and health determinants of disabilities. Data was collected using a standard questionnaire in French. In total, 159 physically disabled subjects were enrolled in the study. Mean age was 36 years [± SD 17.26], 55.9% of subjects were female, and 33.8% had a low educational-level. The most frequently reported disabilities were orthopaedic problems (mainly fractures) [45.8%], infectious diseases [29.1%]), and neurological disabilities (mainly hemiplegia [33.3%], hemiparesis [23.8%], and monoplegia [23.8%]). The main causes of disability were trauma due to traffic accidents (17.8%) and inappropriate medical interventions (14.5%). Disability was related to age and 50% of participants experienced social discrimination. Disabled subjects with low-incomes (from 50.000 to 200.000 XAF) were required to pay for rehabilitative care (XAF 10.000 to 100.000), and up to 83% had appealed for improved quality of Rehabilitation Medicine. Although Law n. 83/013 for the protection of persons with disabilities in Cameroon dates back to 1983, the results of this study show that disabled people, and children in particular, are still marginalized, vulnerable and have little chance of recovery. Therefore, there is a clear need to improve the quality and availability of rehabilitative care services , with programmatic interventions that ensure implementation of existing laws, improve access to rehabilitative services, provide disabled persons with the necessary specialty medical products, and eliminate barriers to their social

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

Science.gov (United States)

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

2012-01-01

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

In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration.

Science.gov (United States)

Blom, M T; Jansen, S; de Jonghe, A; van Munster, B C; de Boer, A; de Rooij, S E; Tan, H L; van der Velde, N

2015-05-01

Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms). Prospective cohort study. Tertiary university teaching-hospital. Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients. Data from ECGs made before and after hip surgery (1-3 days and/or 4-6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis. We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors. QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.

Approaches and perioperative management in periacetabular osteotomy surgery

DEFF Research Database (Denmark)

Søballe, Kjeld; Troelsen, Anders

2012-01-01

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

Predictors of disability retirement.

Science.gov (United States)

Krause, N; Lynch, J; Kaplan, G A; Cohen, R D; Goldberg, D E; Salonen, J T

1997-12-01

Disability retirement may increase as the work force ages, but there is little information on factors associated with retirement because of disability. This is the first prospective population-based study of predictors of disability retirement including information on workplace, socioeconomic, behavioral, and health-related factors. The subjects were 1038 Finnish men who were enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study, who were 42, 48, 54, or 60 years of age at the beginning of the study, and who participated in a 4-year follow-up medical examination. Various job characteristics predicted disability retirement. Heavy work, work in uncomfortable positions, long workhours, noise at work, physical job strain, musculoskeletal strain, repetitive or continuous muscle strain, mental job strain, and job dissatisfaction were all significantly associated with the incidence of disability retirement. The ability to communicate with fellow workers and social support from supervisors tended to reduce the risk of disability retirement. The relationships persisted after control for socioeconomic factors, prevalent disease, and health behavior, which were also associated with disability retirement. The strong associations found between workplace factors and the incidence of disability retirement link the problem of disability retirement to the problem of poor work conditions.

Disabled children and their families in Ukraine: health and mental health issues for families caring for their disabled child at home.

Science.gov (United States)

Bridge, Gillian

2004-01-01

In the Eastern European countries included in the communist system of the USSR, parents of disabled children were encouraged to commit their disabled child to institutional care. There were strict legal regulations excluding them from schools. Medical assessments were used for care decisions. Nevertheless many parents decided to care for their disabled child at home within the family. Ukraine became an independent country in 1991, when communism was replaced by liberal democracy within a free market system. Western solutions have been sought for many social problems existing, but 'hidden,' under the old regime. For more of the parents of disabled children, this has meant embracing ideas of caring for their disabled children in the community, and providing for their social, educational, and medical needs, which have previously been denied. The issue of disability is a serious one for Ukraine where the nuclear disaster at Chernobyl in 1986 caused extensive radiation poisoning. This almost certainly led to an increase in the number of disabled children being born and an increase in the incidence of various forms of cancer. This paper is based on a series of observation visits to some of the many self-help groups established by parents, usually mothers, for their disabled children. It draws attention to the emotional stress experienced both by parents and their disabled children in the process of attempting to come to terms with the disabling conditions, and the denial of the normal rights of childhood resulting from prejudice, poor resources, ignorance, and restrictive legislation. Attempts have been made to identify the possible role and tasks of professional social workers within this context. International comparisons show that many parents and their children do not benefit from the medical model of disability, and that serious consequences include the development of depressive illness among those who find that little help is available from public services.

Disability disclosure and workplace accommodations among youth with disabilities.

Science.gov (United States)

Lindsay, Sally; Cagliostro, Elaine; Leck, Joanne; Shen, Winny; Stinson, Jennifer

2018-03-20

Many youths with disabilities find it challenging to disclose their medical condition and request workplace accommodations. Our objective was to explore when and how young people with disabilities disclose their condition and request workplace accommodations. We conducted 17 in-depth interviews (11 females, six males) with youth with disabilities aged 15-34 (mean age 26). We analyzed our data using an interpretive, qualitative, and thematic approach. Our results showed the timing of when youth disclosed their disability to their employer depended on disability type and severity, comfort level, type of job, and industry. Youth's strategies and reasons for disclosure included advocating for their needs, being knowledgeable about workplace rights, and accommodation solutions. Facilitators for disclosure included job preparation, self-confidence, and self-advocacy skills, and having an inclusive work environment. Challenges to disability disclosure included the fear of stigma and discrimination, lack of employer's knowledge about disability and accommodations, negative past experiences of disclosing, and not disclosing on your own terms. Our findings highlight that youth encounter several challenges and barriers to disclosing their condition and requesting workplace accommodations. The timing and process for disclosing is complex and further work is needed to help support youth with disclosing their condition. Implications for rehabilitation Clinicians, educators, and employers should emphasize the importance of mentoring and leadership programs to give youth the confidence and self-advocacy skills needed to disclose and ask for accommodations in the workplace. Clinicians should advocate for the inclusion of youth with disabilities in the workforce and educate employers on the importance of doing so. Youth with disabilities need more opportunities for employment training and particularly how to disclose their disability and request workplace accommodations.

Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience.

Science.gov (United States)

Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-12-01

OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown. METHODS A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes. RESULTS One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0

Prognostic indicators for perioperative survival after diaphragmatic herniorrhaphy in cats and dogs: 96 cases (2001-2013).

Science.gov (United States)

Legallet, Claire; Thieman Mankin, Kelley; Selmic, Laura E

2017-01-07

To determine associations between perioperative mortality after surgery for traumatic diaphragmatic hernia, medical records of 17 cats and 79 dogs that underwent diaphragmatic herniorrhaphy were reviewed. The combined perioperative survival rate was 81.3% (88.2% in cats and 79.8% in dogs). Data from acute and chronic cases was assessed separately. Of the acute cases (12 cats and 48 dogs), 10 cats (83.3%) and 38 dogs (79.2%) survived to discharge. Of the chronic cases (5 cats and 31 dogs), 5 cats (100%) and 25 dogs (80.6%) survived to discharge. The time between trauma and surgery, trauma and admission, and admission and surgery were not associated with survival. For cats and dogs, increased duration of anesthesia and surgical procedure were associated with increased mortality (P = 0.0013 and 0.004, respectively). Animals with concurrent soft tissue injuries had a 4.3 times greater odds of mortality than those without soft tissue injury (P = 0.01). Animals with concurrent soft tissue and orthopedic injuries had a 7.3 times greater odds of mortality than those without soft tissue and orthopedic injuries (P = 0.004). Animals that were oxygen dependent had a 5.0 times greater odds of mortality than those that were not (P = 0.02). No other variables were significantly associated with survival. For cats and dogs that underwent surgery for traumatic diaphragmatic hernia, increased anesthetic duration, increased duration of surgical procedure, concurrent soft tissue injuries, concurrent soft tissue and orthopedic injuries, and perioperative oxygen dependence were associated with increased mortality.

Sleep and Cognitive Functioning in Children with Disabilities

Science.gov (United States)

Buckhalt, Joseph A.

2013-01-01

Sleep disorders and sleep of insufficient duration and quality have been associated with impaired cognitive functioning in typically developing children and in children with a wide array of disabilities and medical conditions. Among children with disabilities, those with intellectual disability, attention deficit hyperactivity disorder, and autism…

(dis)Ability and Music Education: Paralympian Patrick Anderson and the Experience of Disability in Music

Science.gov (United States)

Bell, Adam Patrick

2017-01-01

What does it mean to experience disability in music? Based on interviews with Patrick Anderson--arguably the greatest wheelchair basketball player of all time--this article presents insights into the complexities of the experience of disability in sports and music. Contrasted with music education's tendency to adhere to a medicalized model of…

Improving Accessibility to Medical Services for Persons with Disabilities in Thailand

Directory of Open Access Journals (Sweden)

Anpatcha Sakhornkhan

2012-06-01

Full Text Available Purpose: This action research aimed at developing an action plan to improve the accessibility to home health care and assistive devices for persons with disabilities in a rural community, and to evaluate changes in the numbers of such persons who received appropriate home health care and assistive devices after a three-month implementation of the action plan.Method: The study was conducted at a sub-district of Maha Sarakham Province, Thailand. The main beneficiaries were 99 persons with disabilities (mean age55.4±18.7 years. Group meetings were organised for persons with disabilities, caregivers, and various community members. An action plan for improving the accessibility of persons with disabilities to home health care and assistive devices was collaboratively formulated and implemented for three months.Results: The main strategy for improving accessibility was to increase the competency of village health volunteers in providing home health care and assistive devices to persons with disabilities. After the three-month action plan implementation, the number of persons with disabilities who received appropriate home health care, i.e. at least once a month, significantly increased from 33.3% to 72.2% (Chi-square test, PConclusions: Under the supervision of physical therapists and/or other allied health professionals, the village health volunteer is likely to be a key person for improving the accessibility to home health care and assistive devices for persons with disabilities in a rural community.Limitations: The study was limited to only one sub-district. No comparable areas were studied. Further, since the study recruited persons with disabilities from a rural community, applicability of the findings to persons with disabilities in an urban community should be considered judiciously.

Perioperative lung protective ventilation in obese patients

NARCIS (Netherlands)

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

2015-01-01

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

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.

Science.gov (United States)

Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F; Shaw, Andrew D; Thacker, Julie K M; Gan, Tong J; Miller, Timothy E; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike

2017-12-29

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using

Ischemic Heart Disease and Work Disability in Patients Treated at the Internal Medicine Consultation and Assessed by the Expert Medical Labor Commission

Directory of Open Access Journals (Sweden)

Belkis Vicente Sánchez

2016-02-01

Full Text Available Background: ischemic heart disease represents a major challenge given the large number of people affected by this condition, its increasing contribution to overall mortality, the frequent disability resulting from it, and the complexity and high cost of its treatment. Objective: to describe the work disability caused by ischemic heart disease in patients treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality. Methods: a cross-sectional study was conducted including all patients with ischemic heart disease treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality from October 2012 to July 2013. The variables analyzed were: age, sex, occupation, years of work and accrued salary, clinical diagnosis, length of time the condition had been present and associated chronic diseases; existence of prior assessment by an Expert Medical Labor Commission and decision reached, previous days of sick leave and current decision of the commission. The data were analyzed using SPSS (version 18.0 and the results are shown in tables and graphs as numbers and percentages. Results: a predominance of men was observed. Forty two point nine percent were service workers and the average number of years of work was 24.60. Forty two point nine percent were previously assessed by the commission. Two hundred one point thirteen days of sick leave were granted and social security expenditure in a month was high. Diabetes mellitus was the most common chronic disease followed by hypertension, obesity and dyslipidemia. Of the workers previously assessed, half received permanent and temporary disability benefits. Conclusions: ischemic heart disease causes different degrees of disability. Its costs in terms of social security are increasing.

Using games to provide interactive perioperative education.

Science.gov (United States)

Carifa, Linda; Janiszewski Goodin, Heather

2011-10-01

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

Disability studies and health care curriculum: the great divide.

Science.gov (United States)

Hubbard, Sandra

2004-01-01

Models or paradigms of disability are used to guide health care professionals' perceptions so that they can serve people with disabilities, enhance their futures, and facilitate the resources they need. Health care curricula, which in essence train students to make such decisions, are influenced by these models. The medical model, which locates disability within the individual, assumes the individual with a disability is a victim who must be cured or made more normal. The functional-limitation paradigm expands on the medical model, focusing on the interaction of physical or mental limitations with social and environmental factors. The economic model, based on the concept of employability, emphasizes a health-related inability (or limited ability) to work rather than physical functioning of the individual. The sociopolitical model views disability as a policy and civil rights issue. Health care professionals face a dilemma as the disability rights movement demands a shift in social power from the paternalistic view of the medical model to the autonomist view of the sociopolitical model. The question is asked if curricula are preparing our future health care professionals to distinguish how to view each situation and each individual through the lens of the appropriate model.

The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases.

Science.gov (United States)

Lau, Darryl; Osorio, Joseph A; Deviren, Vedat; Ames, Christopher P

2018-04-06

OBJECTIVE Three-column osteotomies are increasingly being used in the elderly population to correct rigid spinal deformities. There is hesitation, however, in performing the technique in older patients because of the high risk for blood loss, longer operative times, and complications. This study assesses whether age alone is an independent risk factor for complications and length of stay. METHODS All patients with thoracolumbar adult spinal deformity (ASD) who underwent 3-column osteotomy (vertebral column resection or pedicle subtraction osteotomy) performed by the senior author from 2006 to 2016 were identified. Demographics, clinical baseline, and surgical details were collected. Outcomes of interest included perioperative complication, ICU stay, and hospital stay. Bivariate and multivariate analyses were used to assess the association of age with outcomes of interest. RESULTS A total of 300 patients were included, and 38.3% were male. The mean age was 63.7 years: 10.3% of patients were younger than 50 years, 36.0% were 50-64 years, 45.7% were 65-79 years, and 8.0% were 80 years or older. The overall mean EBL was 1999 ml. The overall perioperative complication rate was 24.7%: 18.0% had a medical complication and 7.0% had a surgical complication. There were no perioperative or 30-day deaths. Age was associated with overall complications (p = 0.002) and medical-specific complications (p column osteotomy for ASD. Comorbidities and other unknown variables that come with age are likely what put these patients at higher risk for complications. Older age, however, is independently associated with longer ICU and hospital stays.

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

Science.gov (United States)

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

2013-12-01

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

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities.

Science.gov (United States)

Zajicek-Farber, Michaela L; Lotrecchiano, Gaetano R; Long, Toby M; Farber, Jon Matthew

2015-08-01

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Would Rethinking Learning Disabilities Benefit Kuwait?

Science.gov (United States)

Bazna, Maysaa; Reid, D. Kim

2009-01-01

Learning disabilities education in Kuwait grew from Kuwaiti's wholesale importation of the Western, medical model of disability--a model basically incompatible with Kuwaiti culture. Conflicting factors include its problematic normal/abnormal binary, its assumption that the "deficit" is located in the student and the segregation of…

Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study.

Directory of Open Access Journals (Sweden)

George A Jelinek

Full Text Available Emerging evidence links modifiable lifestyle risk factors to disease progression in multiple sclerosis (MS. We sought further evidence around this hypothesis through detailed analysis of the association with disability of lifestyle behaviours of a large international sample of people with MS.A total of 2469 people with MS from 57 countries provided self-reported data via cross-sectional online survey on lifestyle (mostly with validated tools and the primary outcome measure, disability (Patient Determined Disease Steps, categorised from 8 steps into 3 categories, mild, moderate and major disability. Multinomial logistic regression modelling derived relative risk ratios (RRRs for disability categories.RRRs of having moderate vs mild disability were: diet (per 30 points on 100 point scale 0.72 (95%CI 0.52-0.98, ever smoking 1.32 (1.06-1.65, exercise (moderate/high vs low 0.35 (0.28-0.44, latitude (per degree from the equator 1.02 (1.01-1.04, and number of comorbidities (2 vs none 1.43 (1.04-1.95, (3 vs none 1.56 (1.13-2.16. RRRs of having major vs mild disability were: exercise (moderate/high vs low 0.07 (0.04-0.11, alcohol consumption (moderate vs low 0.45 (0.30-0.68, plant-based omega 3 supplementation 0.39 (0.18-0.86, and disease-modifying medication use 0.45 (0.29-0.70.Healthier lifestyle has strong associations with disability in our large international sample of people with MS, supporting further investigation into the role of lifestyle risk factors in MS disease progression.

Using a best-practice perioperative governance structure to implement better block scheduling.

Science.gov (United States)

Heiser, Randy

2013-01-01

Achieving, developing, and maintaining a well-functioning OR scheduling system requires a well-designed perioperative governance structure. Traditional OR/surgery committees, consisting mainly of surgeons, have tried to provide this function but often have not succeeded. An OR governance model should be led by an OR executive committee that functions as a board of directors for the surgery program and works closely with the surgery department medical director and an OR advisory committee. Ideally, the OR executive committee should develop a block schedule that includes a mix of block, open, and urgent or emergent OR access, because this combination is most effective for improving OR use and adapting to changes in surgical procedure volume. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Comparative study of perioperative complication rates of cervical laminoplasty performed by residents and teaching neurosurgeons.

Science.gov (United States)

Niimura, Manabu; Takai, Keisuke; Taniguchi, Makoto

2017-11-01

Early surgical education is required for neurosurgical residents to learn many surgical procedures. However, the participation of less experienced residents may increase perioperative complication rates. Perioperative complication studies in the field of neurosurgery are being increasingly published; however, studies have not yet focused on cervical laminoplasty. The study population included 193 consecutive patients who underwent cervical laminoplasty in Tokyo Metropolitan Neurological Hospital between 2008 and 2014. Patient and surgeon background factors, as well as perioperative complication rates were retrospectively compared between resident and board-certified spine neurosurgeon groups. Deteriorated or newly developed neurological deficits and surgical site complications within 30days of cervical laminoplasty were defined as perioperative complications. Out of 193 patients, 123 (64%) were operated on by residents as the first operator and 70 (36%) by board-certified spine neurosurgeons. No significant differences were observed in patient and surgeon factors between the two groups, except for hyperlipidemia (13 vs 17, p=0.02). Furthermore, no significant differences were noted in perioperative complication rates between the two groups (7 [5.7%] vs 4 [5.7%], p=1). Cervical laminoplasty performed in a standardized manner by residents who received their surgical training in our hospital did not increase perioperative complication rates, and ensured the safety of patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Effect of Disability Insurance on Health Investment: Evidence from the Veterans Benefits Administration's Disability Compensation Program

Science.gov (United States)

Singleton, Perry

2009-01-01

I examine whether individuals respond to monetary incentives to detect latent medical conditions. The effect is identified by a policy that deemed diabetes associated with herbicide exposure a compensable disability under the Veterans Benefits Administration's Disability Compensation program. Since a diagnosis is a requisite for benefit…

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

OpenAIRE

Segelman, Josefin; Nygren, Jonas

2014-01-01

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

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

DEFF Research Database (Denmark)

Tengberg, L. T.; Bay-Nielsen, M.; Bisgaard, T.

2017-01-01

Background: Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery...... = 0·004). Conclusion: The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov)....

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

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Renu Bala

2016-01-01

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

Benefits and harms of perioperative beta-blockade

DEFF Research Database (Denmark)

Wetterslev, Jørn; Juul, Anne Benedicte

2006-01-01

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

Disability reconsidered: the paradox of physical therapy.

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Roush, Susan E; Sharby, Nancy

2011-12-01

The purposes of this perspective article are: (1) to explore models of disability from the perspective of the academic discipline of disability studies (DS), (2) to consider the paradox of improving functional capacities while valuing disability as diversity, (3) to identify how physical therapy's use of the International Classification of Functioning, Disability and Health (ICF) disablement model intersects with various disability models, and (4) to apply this broader understanding of disability to physical therapist practice, education, and research. The DS literature has been critical of rehabilitation professionals, particularly targeting the medical model of disability. In contrast, advocates for a social model of disability recognize disability as diversity. It is paradoxical for physical therapy to simultaneously work to ameliorate disability while celebrating it as diversity. The ICF biopsychosocial disablement model offers a mechanism to practice within this paradox and suggests that it is no longer sufficient to conceptualize disability as a purely individual matter that requires attention in isolation from the impact of the larger society.

Strategier til begraensning af det perioperative forbrug af allogent blod

DEFF Research Database (Denmark)

Jørgensen, B G; Qvist, N

2001-01-01

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

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

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

2014-12-01

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

Perioperative lung protective ventilation in obese patients.

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

2015-05-06

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

Perioperative Prophylaxis for Total Artificial Heart Transplantation.

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

2017-11-01

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

Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

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Hannemann, P; Lassen, K; Hausel, J

2006-01-01

-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. METHODS: In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258......-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid...

The treatment of perioperative myocardial infarctions following ...

African Journals Online (AJOL)

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

Medical Readers' Theater: Relevance to Geriatrics Medical Education

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Shapiro, Johanna; Cho, Beverly

2011-01-01

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

[How to write a medical report for the assessment of disability].

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Calvet, Xavier; Motos, Jaume; Villoria, Albert

2014-01-07

The present article revises practical aspects on the format and content of the clinical reports used for the evaluation of disability for the Spanish Disability Grants System. As a framework for understanding how these clinical reports should be, the review includes also a short overview of the different types of disability grants and the administrative and court mechanisms for granting. Copyright © 2013 Elsevier España, S.L. All rights reserved.

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

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Tumul Chowdhury

2013-01-01

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

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

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Yamakage, Michiaki; Iwasaki, Sohshi; Namiki, Akiyoshi

2008-01-01

Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

YHD in Struggle for Independent Living for Disabled

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Elena Pečarič

2013-09-01

Full Text Available The YHD group (Youth Handicapped Deprivileged was shaped from the need of young disabled students who wanted to taste freedom and independence. Through revolt, persistence and thirst for answers, the informal movement Youth Handicapped Deprivileged was established. It was later transformed into YHD – Association for Theory and Culture of Handicap. YHD found a home in ACC Metelkova and has stayed there for 20 years. The theory of handicap and revolt against medical comprehension of disability are the principal guidelines to which the Associations’ projects and actions adhere. Other associations for disabled people are centered around medical diagnoses of its members, whereas YDH aims to bring about positive changes concerning the position of handicapped people in the society. For YHD, disability is a social status and not a characteristic of the body or a mental condition, difficulty or »special need«. YHD rejects a pre-written script for the lives of the disabled.

Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

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Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

2017-11-01

While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

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

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

2017-06-01

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

Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

Science.gov (United States)

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

2017-01-01

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

Inhaled therapy for the management of perioperative pulmonary hypertension

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C A Thunberg

2015-01-01

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

Who occupies disability?

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Nick Pollard

2017-06-01

Full Text Available Locating occupational therapy within gendered and racialized systems of power, the authors consider the intersectional nature of critical disability studies discourse and the need for occupational therapy to incorporate such values into practice. This article discusses ways in which occupational therapy as a profession and individual therapists can align with or resist the economic determination which has come to dominate medical systems. It considers some of the political background to the history of the profession and its relationship with power. This positioning of the profession is explored against the impact of neoliberal economic policy on health, rights, service delivery and disability, and against some key issues, the pressure of ageing populations and the positon of occupational therapists as women professionals. Current policies present a critical challenge to central occupational therapy tenets. Occupational therapists may find themselves working both in alliance with disabled people and disability activists, and against them.

Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

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Kernan Scott

2010-01-01

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

Health care for people with disability

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Francisco Javier Leturia Arrazola

2014-06-01

Full Text Available Although the majority of disabled people aren’t or don’t feel ill, and despite that they should be taken care of by the general medical services as many other citizens, most of them need a more intense and frequent health care. This is explained by a higher prevalence of some medical conditions as well as a higher risk of comorbidity among the people with disabilities (in comparison to the general population. At the moment there are many problems concerning accessibility, underdiagnose and overtreatment. National health systems should be able to offer all their services adapted to disabled people in order to obtain results for this group that are similar to those of the rest of the population. To achieve this objective it is necessary to improve professional competencies and skills and develop some specific health programmes.

Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

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Xiaobo Cui

2012-01-01

Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations

DEFF Research Database (Denmark)

Mathiesen, O; Wetterslev, Jørn; Kontinen, V K

2014-01-01

with the most common perioperative non-opioid analgesics: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta-analyses of analgesic efficacy and/or adverse effects...... of perioperative non-opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post-operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality...

Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

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Marilia Ferrari Conchon

2015-02-01

Full Text Available A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

Validation of computerized sniffer for monitoring perioperative normothermia.

Science.gov (United States)

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

2013-01-01

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

Expanded Disability Status Scale-Based Disability and Dental-Periodontal Conditions in Patients with Multiple Sclerosis.

Science.gov (United States)

Hatipoglu, Hasan; Canbaz Kabay, Sibel; Gungor Hatipoglu, Mujgan; Ozden, Hilmi

2016-01-01

The aim of this study was to evaluate the association between different disability states in patients with multiple sclerosis (MS) as determined by the expanded disability status scale (EDSS) and dental-periodontal measures. Eighty patients with MS (64 females and 16 males) were included in this study. Data on MS types, attack frequency, disease duration, EDSS scores and orofacial complaints prior to an MS attack were obtained from medical records. The plaque index (PI), probing depth (PD), clinical attachment level (CAL), gingival index (GI), decayed-missing-filled teeth (DMFT) index and number of present teeth were measured during one dental examination for each subject. The MS patients were divided into the following 2 groups based on their EDSS scores: low physical disability (L-DS) and high physical disability (H-DS). Differences in dental parameters between groups of low and high disability were investigated. p disability in MS patients. In addition, some maxillofacial-oral complaints prior to an MS attack were observed. © 2015 S. Karger AG, Basel.

State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004.

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Armour, Brian S; Campbell, Vincent A; Crews, John E; Malarcher, Ann; Maurice, Emmanuel; Richard, Roland A

2007-10-01

To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers. We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers. We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available. Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service's clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.

Fibromyalgia and Obesity: The Association Between Body Mass Index and Disability, Depression, History of Abuse, Medications, and Comorbidities.

Science.gov (United States)

Gota, Carmen E; Kaouk, Sahar; Wilke, William S

2015-09-01

The aim of this study was to determine the frequency of increasing body mass index (BMI) in fibromyalgia (FM) and to understand the impact of increasing BMI on FM. Patients with FM were divided into 3 BMI classifications: normal weight, overweight, and obese. We then sought relationships of increasing BMI to core process FM variables and symptoms and disability, as well as medical comorbidities and demographic, socioeconomic, psychiatric, and treatment data. Of 224 patients, 0.4% were underweight; 25.9%, normal weight; 29.9%, overweight; 43.8%, obese. We found no differences within groups with regard to age, gender, demographics, FM symptoms, FM impact questionnaire scores, and meeting the American College of Rheumatology 1990 criteria and FM survey criteria. Patients with FM who are obese, compared with normal-weight patients, have higher depression scores measured by Patient Health Questionnaire 9 (13.2 [6.6] vs 10.5 [6], P = 0.03), report increased disability by Health Assessment Questionnaire Disability Index scores (1.3 [0.6] vs 0.9 [0.6], P BMI with the Health Assessment Questionnaire Disability Index (not FM impact questionnaire) and depression. We confirm that the prevalence of overweight and obesity is high in FM and believe that physicians treating FM should be aware of our bivariate linear correlations and discuss weight loss with their FM patients. Even if increasing BMI is not intrinsic to FM, it contributes to poor mood and functional outcome and should be a treatment goal.

Time allocation of disabled individuals.

Science.gov (United States)

Pagán, Ricardo

2013-05-01

Although some studies have analysed the disability phenomenon and its effect on, for example, labour force participation, wages, job satisfaction, or the use of disability pension, the empirical evidence on how disability steals time (e.g. hours of work) from individuals is very scarce. This article examines how disabled individuals allocate their time to daily activities as compared to their non-disabled counterparts. Using time diary information from the Spanish Time Use Survey (last quarter of 2002 and the first three quarters of 2003), we estimate the determinants of time (minutes per day) spent on four aggregate categories (market work, household production, tertiary activities and leisure) for a sample of 27,687 non-disabled and 5250 disabled individuals and decompose the observed time differential by using the Oaxaca-Blinder methodology. The results show that disabled individuals devote less time to market work (especially females), and more time to household production (e.g. cooking, cleaning, child care), tertiary activities (e.g., sleeping, personal care, medical treatment) and leisure activities. We also find a significant effect of age on the time spent on daily activities and important differences by gender and disability status. The results are consistent with the hypothesis that disability steals time, and reiterate the fact that more public policies are needed to balance working life and health concerns among disabled individuals. Copyright © 2013 Elsevier Ltd. All rights reserved.

Fluid therapy in the perioperative setting-a clinical review

DEFF Research Database (Denmark)

Voldby, Anders Winther; Brandstrup, Birgitte

2016-01-01

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

Attractiveness, diagnostic ambiguity, and disability cues impact perceptions of women with pain.

Science.gov (United States)

LaChapelle, Diane L; Lavoie, Susan; Higgins, Nancy C; Hadjistavropoulos, Thomas

2014-05-01

This experimental study investigated how physical attractiveness, disability cue, and diagnostic ambiguity stereotypes impact perceptions of a patient's pain/disability and personality. After viewing photographs of women pictured with or without a cane, accompanied by descriptions of the women's diagnosis (fibromyalgia or rheumatoid arthritis), 147 university students rated the women's pain/disability and personality. Analyses revealed that more attractive women received lower ratings on pain/disability and higher ratings (more positive) on personality. Moreover, those pictured with a disability cue got higher ratings on both pain/disability and personality, and those with medical evidence of pathology (less ambiguity) got higher ratings on pain/disability and lower ratings on personality. Examination of the 3 stereotypes in a single study enabled an evaluation of their interactions. An Attractiveness × Disability Cue × Diagnostic Ambiguity interaction for ratings of pain/disability revealed that the presence of both medical evidence and a disability cue were needed to override the strong "beautiful is healthy" stereotype. Significant 2-way interactions for ratings of personality indicated that the impact of the disability stereotype tends to be overshadowed by the attractiveness stereotype. The results indicate that these stereotypes have a large effect on perceptions of women with chronic pain and that attractiveness, a contextual variable unrelated to the pain experience, exerts an even stronger effect when there is less objective information available. This could have clinical ramifications for assessment and treatment of patients with chronic pain, which often occurs in the absence of "objective" medical evidence or any external cues of disability. (c) 2014 APA, all rights reserved.

Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists.

Science.gov (United States)

Davis, Sharon R; Durvasula, Seeta; Merhi, Diana; Young, Paul M; Traini, Daniela; Bosnic Anticevich, Sinthia Z

2016-02-01

Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants' homes, the point of health care access, or the offices of relevant support organisations. In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants. This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative

DEFF Research Database (Denmark)

Myles, P S; Boney, O; Botti, M

2018-01-01

Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus...

20 CFR 416.1019 - Quick disability determination process.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Quick disability determination process. 416.1019 Section 416.1019 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... disagreement between the disability examiner and the medical or psychological consultant, the State agency will...

Disability in Fibromyalgia Associates with Symptom Severity and Occupation Characteristics.

Science.gov (United States)

Fitzcharles, Mary-Ann; Ste-Marie, Peter A; Rampakakis, Emmanouil; Sampalis, John S; Shir, Yoram

2016-05-01

It is intuitive that disability caused by illness should be reflected in illness severity. Because disability rates for fibromyalgia (FM) are high in the developed world, we have examined disease and work characteristics for patients with FM who were working, unemployed, or receiving disability payments for disability as a result of FM. Of the 248 participants in a tertiary care cohort study of patients with FM, 90 were employed, 81 were not employed and not receiving disability payments, and 77 were not working and currently receiving disability payments awarded for disability caused by FM. Demographic, occupation, and disease characteristics were compared among the groups. The prevalence of disability caused by FM was 30.8%. There were no demographic differences among the working, unemployed, or disabled patients. With the exception of measures for anxiety and depression, all measurements for disease severity differed significantly among the groups, with greater severity reported for the disabled group, which used more medications and participated less in physical activity. Disabled patients were more likely previously employed in manual professions or the service industry, whereas employed patients were more commonly working in non-manual jobs that included clerical, managerial, or professional occupations (p = 0.005). The one-third rate of disability for this Canadian cohort of patients with FM is in line with other reports from the western world. Associations of disability compensation were observed for subjective report of symptom severity, increased use of medications, and previous employment in more physically demanding jobs.

Disability Evaluation Systems Analysis and Research Annual Report 2015

Science.gov (United States)

2016-03-21

Army and Air Force had higher percentages of reserve component disability evaluations, likely due to the inclusion of National Guard service members...Annual Report 2015 Disability Evaluation Systems Analysis and Research Prepared by Accession Medical Standards Analysis and Research Activity...Preventive Medicine Branch Walter Reed Army Institute of Research Silver Spring, Maryland Disability Evaluation Systems Analysis and Research

Considering the culture of disability in cultural competence education.

Science.gov (United States)

Eddey, Gary E; Robey, Kenneth L

2005-07-01

Cultural competence extends beyond understanding those values, beliefs, and needs that are associated with patients' age or gender or with their racial, ethnic, or religious backgrounds. People hold many simultaneous cultural associations, and each have implications for the care process. The "culture of disability" is a pan-ethnic culture for which a set of physician competencies are required to ensure appropriate, culturally sensitive care to persons with congenital or acquired disabilities. Such competencies include communicating with patients who have deficits in verbal communication and avoidance of infantilizing speech; understanding the values and needs of persons with disabilities; the ability to encourage self-advocacy skills of patients and families; acknowledging the core values of disability culture including the emphasis on interdependence rather than independence; and feeling comfortable with patients with complex disabilities. Medical schools have developed programs to increase students' exposure to persons with disabilities and it is suggested that such programs are most effective when they are the result of collaboration with community-based facilities or organizations that serve persons with disabilities in the natural environment. Combining lecture-based instruction and structured experiences with the opportunity for students to interact with patients in their natural environments may facilitate development of competencies with respect to patients with disabilities. The culture of disability should be included as one of the many cultures addressed in cultural competence initiatives in medical school and residency curricula.

Optimization of peri-operative care in colorectal surgery

NARCIS (Netherlands)

Kornmann, V.N.N.

2016-01-01

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

Perioperative interstitial brachytherapy for recurrent keloid scars

International Nuclear Information System (INIS)

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

2010-01-01

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

[A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

Science.gov (United States)

Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

2010-07-01

We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

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

Science.gov (United States)

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

2017-01-01

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

Social assistance and disability in Brazil: the reflection of the international debate of the rights of people with disability

Directory of Open Access Journals (Sweden)

Wederson Rufino dos Santos

2010-07-01

Full Text Available This paper reviews the debate on the social model of disability has influenced conceptions of the International Classification of Functioning, Disability and Health adopted by the World Health Organization in 2001 and adopted in Brazil in 2007, through the law of the Continuous Cash Benefit. The BPC is a major social policy of income transfer to poor disabled people, affecting over one million and half disabled people in the country. Since 2009, the evaluation of persons with disabilities for the BPC will make by medical and social skills targeted by ICF. Will be demonstrated that, although the adoption of the ICF maybe to represent regard to how to understand disability as social inequality, the adoption of the ICF by the law of the BPC will face challenges in ensuring the right to dignity of disabled people.

20 CFR 416.989 - We may conduct a review to find out whether you continue to be disabled.

Science.gov (United States)

2010-04-01

... continuing disability review. In doing a medical review, we will develop a complete medical history of at... ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Continuing Or Stopping Disability Or Blindness § 416.989 We may conduct a review to find out...

Perioperative solutions for rapid recovery joint arthroplasty: get ahead and stay ahead.

Science.gov (United States)

Sculco, Peter K; Pagnano, Mark W

2015-04-01

Rapid recovery after total joint arthroplasty requires patients to get ahead and stay ahead or the four impediments to early rehabilitation and discharge: volume depletion, blood loss, pain, and nausea. Adequate volume resuscitation starts before entering the operating room and focuses on intravenous fluids rather than red blood cell transfusion. Tranexamic acid limits blood loss and reduces the need for most other blood management systems. Rapid recovery pain management focuses on minimizing parenteral opioids. A short-acting spinal with a peri-articular local anesthetic injection is reliable, reproducible, and safe. Patients at risk for post-operative nausea are treated with anti-emetic medications and perioperative dexamethasone. These interventions reflect a transition from the sick-patient model to the well-patient model and make rapid recovery joint arthroplasty a reality in 2015. Copyright © 2015 Elsevier Inc. All rights reserved.

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

Beydler, Kathy Williams

2017-10-01

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

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

Science.gov (United States)

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

2010-01-01

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

Robots, Disability, and Good Human Life

Directory of Open Access Journals (Sweden)

Antonio Carnevale

2015-02-01

Full Text Available In this paper, I want to show the role that emerging robotic technologies could play in the future in daily life of disabled people. When I talk about disability, I mean any temporary or permanent limitation due to a chronic disease and deficit, as well as, socially disadvantaged conditions, which imply functional and emotional restrictions experienced at any age. All these limitations can be characterized by a specific mental and physical impairment or, more often, by a cluster of medical impairments and social barriers. To this end, the academic literature has generally differentiated between two disability models: 'medical' versus 'social'. The main attempt of this paper consists into showing how the development of robotic technologies — particularly in assistive and healthcare fields — could allow us to go beyond this outdated dichotomy, contributing to create new philosophical premises to rethink the universality of the human condition, that is, the sense of what we intend for 'good human life'.

Patient satisfaction with the perioperative surgical services and ...

African Journals Online (AJOL)

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

Infertility: Inability or Disability?

Directory of Open Access Journals (Sweden)

Abha Khetarpal

2012-06-01

Full Text Available Disability is a complex phenomenon. It reflects an interaction between features of a person’s body and features of the society in which he or she lives. International Classification of Functioning, Disability and Health (ICF, lays stress on the functional as well as the structural problem of a person. All the definitions of disability also include the disorders of the reproductive and endocrine system. So infertility and impotency should also be included in the category of disability. It affects the participation in areas of life and can have a disabling affect on an individual. Like any other disability the couple has to adapt and integrate infertility in their sense of self thus infertility comes as a major life crisis. Medically, infertility, in most cases, is considered to be the result of a physical impairment or a genetic abnormality. Socially, couples are incapable of their reproductive or parental roles. On social level, infertility in most cultures remains associated with social stigma and taboo just like the social model of disability. Couples who are unable to reproduce may be looked down upon due to social stigmatisation. Infertility can lead to divorces and separation leading to a broken family life. Without labelling infertility as a disability, it is difficult for the people to access services and welfare benefits offered by the government. Infertility treatments are highly sophisticated so they are very expensive and are even not covered by insurance and government aid.In the light of all this it becomes imperative to categorise infertility as disability.

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

Science.gov (United States)

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

2016-06-01

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

Perioperative care following complex laryngotracheal reconstruction in infants and children

Directory of Open Access Journals (Sweden)

Gupta Punkaj

2010-01-01

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

Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

LENUS (Irish Health Repository)

O'Brien, Frank J

2012-06-01

It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

The International Classification of Disability, Functioning and Health (ICF) - an example of research methods and language in describing 'social functioning' in medical research

DEFF Research Database (Denmark)

Rasmussen, Gitte

2016-01-01

Medical research ventures into the area of social life with a holistic approach to health and disabilities. However, the specific language developed for this kind of research in the 'ICF' model (adopted by the UN) loses sight of the very phenomena it aims at describing. By contrast, based...

Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.

Science.gov (United States)

Parker, Scott L; Godil, Saniya S; Mendenhall, Stephen K; Zuckerman, Scott L; Shau, David N; McGirt, Matthew J

2014-08-01

Current health care reform calls for a reduction of procedures and treatments that are less effective, more costly, and of little value (high cost/low quality). The authors assessed the 2-year cost and effectiveness of comprehensive medical management for lumbar spondylolisthesis, stenosis, and herniation by utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting. Analysis was performed on a prospective longitudinal quality of life spine registry. Patients with lumbar spondylolisthesis (n = 50), stenosis (n = 50), and disc herniation (n = 50) who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were entered into a prospective registry after deciding on nonsurgical treatment. In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents. Two-year patient-reported outcomes, back-related medical resource utilization, and occupational work-day losses were prospectively collected and used to calculate Medicare fee-based direct and indirect costs from the payer and societal perspectives. The maximum health gain associated with medical management was defined as the improvement in pain, disability, and quality of life experienced after 2 years of medical treatment or at the time a patient decided to cross over to surgery. The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis. Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement. The 2-year improvement did not achieve a minimum clinically

Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma.

Science.gov (United States)

Kimura, Norihisa; Toyoki, Yoshikazu; Ishido, Keinosuke; Kudo, Daisuke; Yakoshi, Yuta; Tsutsumi, Shinji; Miura, Takuya; Wakiya, Taiichi; Hakamada, Kenichi

2015-05-01

Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival. Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed. Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (Pblood transfusion was independently associated with recurrence (hazard ratio (HR)=2.839 (95 % confidence interval (CI), 1.370-5.884), P=0.005), while perioperative blood transfusion (HR=3.383 (95 % CI, 1.499-7.637), P=0.003) and R1 resection (HR=3.125 (95 % CI, 1.025-9.530), P=0.045) were independent risk factors for poor survival. Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.

Asthma in intellectual disability: are we managing our patients appropriately?

Science.gov (United States)

2016-01-01

People with intellectual disability are a vulnerable group of people with asthma that has, to date, largely been ignored in the medical literature. Although guidelines for medication management for people with intellectual disability suggest asthma is treated as for other populations, there are special considerations that should be taken into account when managing asthma in this group. Due to their cognitive impairment as well as comorbidities, they are likely to require support with asthma self-management, including inhaler use. Their varying degrees of autonomy mean that there is often a need to provide education and information to both the person and their caregivers. Educational aims To understand general principles of health of people with intellectual disability and how this affects the healthcare professional’s approach to asthma management. To understand how intellectual disability affects cognition, autonomy and communication, and therefore the ability of a person to self-manage asthma. To recognise ways of mitigating respiratory disease risk in people with intellectual disability. To describe ways for healthcare professionals to support people with intellectual disability and their caregivers in asthma management. PMID:28210318

[An epidemiological study of visual disability and visual rehabilitation in Beijing].

Science.gov (United States)

Zou, Yan-hong; Ding, Ji-yuan; Peng, Hong; Shi, Ji-liang; Qu, Cheng-yi; Liu, Xi-pu

2009-12-01

To investigate the status of visual disability and the demands for visual rehabilitation services in Beijing. Five hundred and fifty-five persons with visual disability in Beijing from the Second National Survey on Disability of China were involved in this study. Their visual disability and demands for rehabilitation were evaluated. About three fourth of the visual disabled persons were over 60 years of age. Cataract, retinal and choroidal diseases, and glaucoma were the three leading causes of the visual impairment. Medical service was the number one (82.0%) demand for the persons with visual disability, although 89.4% of them had previously received some kinds of medial services. People who had received visual aid devices or rehabilitation training were 26.7% and 5.8%, respectively, while more people showed their demand for these service (36.6% and 11.9%, respectively). The demand for visual rehabilitation varied in different groups of age and severity of disability. Accessibility of high quality medical services for preventable blindness diseases should be further promoted. Public health education on visual rehabilitation is also needed.

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

Science.gov (United States)

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

2016-12-21

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

Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes.

Science.gov (United States)

Eyraud, Rémi; Long, Jean-Alexandre; Snow-Lisy, Devon; Autorino, Riccardo; Hillyer, Shahab; Klink, Joseph; Rizkala, Emad; Stein, Robert J; Kaouk, Jihad H; Haber, Georges-Pascal

2013-06-01

To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for hilar vs nonhilar tumors. The study retrospectively reviewed 364 patients with available computed tomography scans undergoing RAPN. Demographic data and perioperative outcomes results were compared between the hilar (group 1, n = 70) and nonhilar tumors (group 2, n = 294). Multivariate analysis was used to identify predictors of warm ischemia time (WIT), estimated blood loss (EBL), major perioperative complications, and postoperative renal function. There were no differences with respect to demographic variables. Hilar tumors had higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) scores (P hilar tumors were associated with greater operative time (210 vs 180 minutes, P hilar vs nonhilar patients on postoperative day 3 (70.12 vs 74.71 mL/min/1.73 m(2), P = .31) or at last follow-up (72.62 vs 75.78 mL/min/1.73 m(2), P = .40), respectively. Multivariate analysis found hilar location was independently associated with increased WIT without significant changes in EBL, major complications, or postoperative renal function. RAPN represents a safe and effective procedure for hilar tumors. Hilar location for patients undergoing RAPN in a high-volume institution seems not be associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function. Copyright © 2013 Elsevier Inc. All rights reserved.

Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

National Research Council Canada - National Science Library

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

2006-01-01

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

The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys

Science.gov (United States)

Navarro-Mateu, Fernando; Alonso, Jordi; Lim, Carmen C. W.; Saha, Sukanta; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Andrade, Laura H.; Bromet, Evelyn J.; Bruffaerts, Ronny; Chatterji, Somnath; Degenhardt, Louisa; de Girolamo, Giovanni; de Jonge, Peter; Fayyad, John; Florescu, Silvia; Gureje, Oye; Haro, Josep M.; Hu, Chiyi; Karam, Elie G.; Kovess-Masfety, Viviane; Lee, Sing; Medina-Mora, Maria E.; Ojagbemi, Akin; Pennell, Beth-Ellen; Posada-Villa, Jose; Scott, Kate M.; Stagnaro, Juan Carlos; Kendler, Kenneth S.; Kessler, Ronald C.; McGrath, John J.

2017-01-01

Objective While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. Method Lifetime occurrences of 6 types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. Results Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ2 = 190.1, pmental or general medical disorders. PMID:28542726

Development and learning of young children with disabilities

DEFF Research Database (Denmark)

Bøttcher, Louise; Dammeyer, Jesper

This book introduces current theories and research on disability, and builds on the premise that disability has to be understood from the dialectical dynamics of biology, psychology, and culture over time. Based on the newest empirical research on children with disabilities, the book overcomes th...... and degrees of disability through the lens of Vygotsky’s cultural-historical developmental theories. Some of the themes discussed are inclusion, mental health, communication, aids and family life.......This book introduces current theories and research on disability, and builds on the premise that disability has to be understood from the dialectical dynamics of biology, psychology, and culture over time. Based on the newest empirical research on children with disabilities, the book overcomes...... the limitations of the medical and social models of disability by arguing for a dialectical biopsychosocial model. The proposed model builds on Vygotsky’s cultural-historical ideas of developmental incongruence, implying that the disability emerges from the misfit between individual abilities and the cultural...

Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

Directory of Open Access Journals (Sweden)

Priyanka Bhateja

2014-01-01

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

World Health Organization Global Disability Action Plan: The Mongolian Perspective

Directory of Open Access Journals (Sweden)

Fary Khan

2017-01-01

Full Text Available Objective: To provide an update on disability and rehabilitation in Mongolia, and to identify potential barriers and facilitators for implementation of the World Health Organization (WHO Global Disability Action Plan (GDAP. Methods: A 4-member rehabilitation team from the Royal Melbourne Hospital conducted an intensive 6-day workshop at the Mongolian National University of Medical Sciences, for local healthcare professionals (n = 77 from medical rehabilitation facilities (urban/rural, public/private and non-governmental organizations. A modified Delphi method (interactive sessions, consensus agreement identified challenges for rehabilitation service provision and disability education and attitudes, using GDAP objectives. Results: The GDAP summary actions were considered useful for clinicians, policy-makers, government and persons with disabilities. The main challenges identified were: limited knowledge of disability services and rehabilitation within healthcare sectors; lack of coordination between sectors; geo-topographical issues; limited skilled workforces; lack of disability data, guidelines and accreditation standards; poor legislation and political commitment. The facilitators were: strong leadership; advocacy of disability-inclusive development; investment in local infrastructure/human resources; opportunities for coordination and partnerships between the healthcare sector and other stakeholders; research opportunities; and dissemination of information. Conclusion: Disability and rehabilitation is an emerging priority in Mongolia to address the rights and needs of persons with disabilities. The GDAP provides guidance to facilitate access and strengthen rehabilitation services.

Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy.

Science.gov (United States)

Sima, Camelia S; Jarnagin, William R; Fong, Yuman; Elkin, Elena; Fischer, Mary; Wuest, David; D'Angelica, Michael; DeMatteo, Ronald P; Blumgart, Leslie H; Gönen, Mithat

2009-12-01

To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors. Hepatic resection is the most effective treatment for several benign and malign conditions, but may be accompanied by substantial blood loss and the need for perioperative transfusions. While blood conservation strategies such as autologous blood donation, acute normovolemic hemodilution, or cell saver systems are available, they are economically efficient only if directed toward patients with a high risk of transfusion. Using preoperative data from 1204 consecutive patients who underwent liver resection between 1995 and 2000 at Memorial Sloan- Kettering Cancer Center, we modeled the probability of perioperative red blood cell transfusion. We used the resulting model, validated on an independent dataset (n = 555 patients), to develop 2 prediction instruments, a nomogram and a transfusion score, which can be easily implemented into clinical practice. The planned number of liver segments resected, concomitant extrahepatic organ resection, a diagnosis of primary liver malignancy, as well as preoperative hemoglobin and platelets levels predicted the probability of perioperative red blood cell transfusion. The predictions of the model appeared accurate and with good discriminatory abilities, generating an area under the receiver operating characteristic curve of 0.71. Preoperative factors can be combined into risk profiles to predict the likelihood of transfusion during or after elective liver resection. These predictions, easy to calculate in the frame of a nomogram or of a transfusion score, can be used to identify patients who are at high risk for red cell transfusions and therefore most likely to benefit from blood conservation techniques.

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

Science.gov (United States)

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

2015-09-01

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

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

NARCIS (Netherlands)

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

2007-01-01

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

Australian perioperative nurses' experiences of assisting in multi-organ procurement surgery: a grounded theory study.

Science.gov (United States)

Smith, Zaneta; Leslie, Gavin; Wynaden, Dianne

2015-03-01

Multi-organ procurement surgical procedures through the generosity of deceased organ donors, have made an enormous impact on extending the lives of recipients. There is a dearth of in-depth knowledge relating to the experiences of perioperative nurses working closely with organ donors undergoing multi-organ procurement surgical procedures. The aim of this study was to address this gap by describing the perioperative nurses experiences of participating in multi-organ procurement surgical procedures and interpreting these findings as a substantive theory. This qualitative study used grounded theory methodology to generate a substantive theory of the experiences of perioperative nurses participating in multi-organ procurement surgery. Recruitment of participants took place after the study was advertised via a professional newsletter and journal. The study was conducted with participants from metropolitan, rural and regional areas of two Australian states; New South Wales and Western Australia. Thirty five perioperative nurse participants with three to 39 years of professional nursing experience informed the study. Semi structured in-depth interviews were undertaken from July 2009 to April 2010 with a mean interview time of 60 min. Interview data was transcribed verbatim and analysed using the constant comparative method. The study results draw attention to the complexities that exist for perioperative nurses when participating in multi-organ procurement surgical procedures reporting a basic social psychological problem articulated as hiding behind a mask and how they resolved this problem by the basic social psychological process of finding meaning. This study provides a greater understanding of how these surgical procedures impact on perioperative nurses by providing a substantive theory of this experience. The findings have the potential to guide further research into this challenging area of nursing practice with implications for clinical initiatives, management

The economic costs of childhood disability.

Science.gov (United States)

Stabile, Mark; Allin, Sara

2012-01-01

Childhood disabilities entail a range of immediate and long-term economic costs that have important implications for the well-being of the child, the family, and society but that are difficult to measure. In an extensive research review, Mark Stabile and Sara Allin examine evidence about three kinds of costs-direct, out-of-pocket costs incurred as a result of the child's disability; indirect costs incurred by the family as it decides how best to cope with the disability; and long-term costs associated with the child's future economic performance. Not surprisingly, the evidence points to high direct costs for families with children with disabilities, though estimates vary considerably within these families. Out-of-pocket expenditures, particularly those for medical costs, for example, are higher among families with children with a special health care need. An important indirect cost for these families involves decisions about employment. Stabile and Allin examine several studies that, taken together, show that having a child with disabilities increases the likelihood that the mother (and less often the father) will either curtail hours of work or stop working altogether. Researchers also find that having a child with disabilities can affect a mother's own health and put substantial strains on the parents' relationship. In the longer term, disabilities also compromise a child's schooling and capacity to get and keep gainful employment as an adult, according to the studies Stabile and Allin review. Negative effects on future well-being appear to be much greater, on average, for children with mental health problems than for those with physical disabilities. Stabile and Allin calculate that the direct costs to families, indirect costs through reduced family labor supply, direct costs to disabled children as they age into the labor force, and the costs of safety net programs for children with disabilities average $30,500 a year per family with a disabled child. They note

Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

Directory of Open Access Journals (Sweden)

Anil A Thomas

2014-01-01

Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.

Current aspects of perioperative fluid handling in vascular surgery

NARCIS (Netherlands)

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

2009-01-01

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

A survey of anticoagulation practice among German speaking microsurgeons – Perioperative management of anticoagulant therapy in free flap surgery [Erhebung über die antikoagulatorische Praxis unter deutschsprachigen Mikrochirurgen – Perioperatives Management der antikoagulatorischen Therapie bei freien Lappentransplantaten

Directory of Open Access Journals (Sweden)

Jokuszies, Andreas

2012-02-01

Full Text Available [english] Background: Anticoagulation is a crucial element in microsurgery. Although various clinical studies and international surveys have revealed that anticoagulation strategies can vary and result in similar outcomes, anticoagulative regimen are far away from standardization. In Germany and german speaking countries standardized anticoagulation protocols concerning free flap surgery do not exist so far. Methods: To evaluate the current practice of clinics in Germany, Austria and Switzerland with specialization in microsurgery we performed a questionnaire surveying the perioperative regimen of anticoagulant and antiplatelet therapy in free flap surgery. The microsurgeons were interrogated on several anticoagulant, rheologic and antiplatelet medications, their dosage and perioperative frequency of application pre-, intra- and postoperative.Results: The questionnaire revealed that the used antithrombotic and perioperative regimens varied from department to department presumably based on the personal experience of the surgeon. Multiple approaches are used with a wide range of anticoagulants used either alone or in combination, with different intervals of application and different dosages. Conclusion: Therefore consensus meetings should be held in future leading to conduct prospective multicenter studies with formulation of standardized anticoagulative and perioperative protocols in microsurgery reducing flap failure to other than pharmacologic reasons.[german] Hintergrund: Die Antikoagulation stellt ein zentrales Element in der Mikrochirurgie dar. Zahlreiche klinische Studien und internationale Erhebungen zu antikoagulatorischen Strategien weisen eine grosse Varianz bei vergleichbaren Resultaten nach, entbehren jedoch einer Standardisierung. Auch in Deutschland und deutschsprachigen Ländern fehlen bislang standardisierte Regime zur Antikoagulation in der Mikrochirurgie.Methodik: Zur Erhebung der antikoagulatorischen Praxis unter

Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

NARCIS (Netherlands)

Kiebert, G. M.; Hanneke, J.; de Haes, J. Hanneke C. J. M.; Kievit, J.; van de Velde, C. J.

1990-01-01

Since chemotherapy is assumed to have a negative impact on quality of life, the impact of peri-operative chemotherapy on physical, psychological and social well-being and on the activity level of patients with early stage breast cancer was investigated. 24 women received peri-operative chemotherapy

Perioperative lung protective ventilation in obese patients

OpenAIRE

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

2015-01-01

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

Important issues for perioperative systemic antimicrobial prophylaxis in surgery

NARCIS (Netherlands)

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

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

The Right to Live--Disability Is Not a Crime.

Science.gov (United States)

Blumberg, Lisa

1984-01-01

A physically disabled individual shares her horror at decisions of parents and doctors to deny medical treatment to handicapped infants. She avers that every child is born with a mix of talents and shortcomings, some more marked than others, and that disability should not be punished. (CL)

Duty and dilemma: Perioperative nurses hiding an objection to participate in organ procurement surgery.

Science.gov (United States)

Smith, Zaneta

2017-07-01

Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi-organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses' experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience-based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly. © 2016 John Wiley & Sons Ltd.

The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients.

Science.gov (United States)

Orłowski, Krzysztof; Lisowska, Grażyna; Misiołek, Hanna; Paluch, Zbigniew; Misiołek, Maciej

2016-01-01

While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

Update on perioperative management of the child with asthma

Directory of Open Access Journals (Sweden)

Francesco Dones

2012-04-01

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

Learning disabilities: definitions, epidemiology, diagnosis, and intervention strategies.

Science.gov (United States)

Lagae, Lieven

2008-12-01

Learning problems occur in about 5% of school-aged children. Learning disabilities are specific and life-long but present with different school problems at different ages, depending on such factors as age, medical history, family history, and intelligence quotient. Proper individualized diagnosis and treatment plans are necessary to remediate these problems and to offer adequate coping strategies. Many children who have learning problems can be classified into one of two major categories: the dyslexia group or the nonverbal learning disability group. The role of the medical professional is important to guide parents in the diagnostic and therapeutic process.

The social meaning of disability: a reflection on categorisation, stigma and identity.

Science.gov (United States)

Grue, Jan

2016-07-01

As disability becomes an ever more salient concept in international political and legal discourse, its social meaning must be better understood. Traditionally defined in medical terms and as an individual problem, it has for the last several decades increasingly become a socio-politically defined phenomenon. Disability pride has emerged as a social movement patterned after ethnic minority and sexual orientation movements. The one billion people who count as disabled nevertheless have illnesses and impairments that are largely understood as medical problems. Medicine continues to exert great influence on the social meaning of disability in general and the social valuation of various illnesses and impairments in particular. Whereas specific conditions may be socially valued, the overall category and label of disability connotes marginality and stigma. Under these conditions, disability policy, which ought to be a universal concern, risks being construed as a marginal and special-interest issue rather than a broadly relevant topic; this has potentially negative consequences for the majority of disabled people. © 2016 Foundation for the Sociology of Health & Illness.

Nursing reflections from journaling during a perioperative internship.

Science.gov (United States)

Kuiper, Ruth Ann

2004-01-01

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

Menstrual Management for Adolescents With Disabilities.

Science.gov (United States)

Quint, Elisabeth H; O'Brien, Rebecca F

2016-07-01

The onset of menses for adolescents with physical or intellectual disabilities can affect their independence and add additional concerns for families at home, in schools, and in other settings. The pediatrician is the primary health care provider to explore and assist with the pubertal transition and menstrual management. Menstrual management of both normal and abnormal cycles may be requested to minimize hygiene issues, premenstrual symptoms, dysmenorrhea, heavy or irregular bleeding, contraception, and conditions exacerbated by the menstrual cycle. Several options are available for menstrual management, depending on the outcome that is desired, ranging from cycle regulation to complete amenorrhea. The use of medications or the request for surgeries to help with the menstrual cycles in teenagers with disabilities has medical, social, legal, and ethical implications. This clinical report is designed to help guide pediatricians in assisting adolescent females with intellectual and/or physical disabilities and their families in making decisions related to successfully navigating menarche and subsequent menstrual cycles. Copyright © 2016 by the American Academy of Pediatrics.

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

Science.gov (United States)

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

2014-04-01

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

Neurologic Evaluation and Management of Perioperative Nerve Injury.

Science.gov (United States)

Watson, James C; Huntoon, Marc A

2015-01-01

Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management. Studies pertinent to the recognition, evaluation, and treatment of neurologic assessment of perioperative nerve injury and published since the last advisory on the topic are reviewed and a new structured algorithmic approach is proposed. The evolving literature on postoperative inflammatory neuropathies is reviewed to help define the clinical criteria and to identify patients who would benefit from early neurological evaluation. New sections review potential acute interventions to improve neurologic outcome and long-term management of neuropathic pain resulting from perioperative nerve injury.

[Are nail polish, artificial nails and piercings allowed outside the surgical area?Recommendations for the perioperative policy].

Science.gov (United States)

Bucx, M J L; Krijtenburg, P; Scheffer, G J

2017-01-01

- An increasing number of patients wear nail polish, artificial nails or have piercings.- There is uncertainty about the perioperative management of these items, especially when located outside the surgical area.- In the majority of hospitals, patients are urged to remove these items preoperatively, under the assumption that they might cause problems.- Frequently, however, these items cannot be removed straightforwardly.- Nail polish and artificial nails only very rarely cause perioperative problems and therefore do not need to be removed pre-operatively.- The same applies to most piercings, except when located in or near the respiratory tract, if they have sharp endings or if they might cause problems as a result of the perioperative positioning of the patient.- Providing adequate information to the patient, knowledge about removal of these items and documentation of agreed arrangements are all important.- A national guideline concerning perioperative policy is urgently required.

Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

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

2015-10-01

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

International consensus statement on the peri-operative management of anaemia and iron deficiency

DEFF Research Database (Denmark)

Muñoz, M.; Acheson, A. G.; Auerbach, M.

2017-01-01

Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed...... in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace...

Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables: A Cross-Sectional Survey in the General German Population.

Science.gov (United States)

Häuser, Winfried; Schmutzer, Gabriele; Hilbert, Anja; Brähler, Elmar; Henningsen, Peter

2015-10-01

In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

Changes in Canada pension plan disability rules hold implications for physicians.

Science.gov (United States)

Romaniuk, A

1995-12-15

Recent legislative changes to the Canada Pension Plan (CPP) have significantly altered eligibility requirements for disability pensions. A CPP medical adviser explains how the changes affect physicians and examines the federal government's definition of "disability."

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

African Journals Online (AJOL)

Adele

2004-05-03

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

Neurobehavioral assessment of children and adolescents attending a developmental disabilities clinic.

Science.gov (United States)

Brasić, James Robert; Barnett, Jacqueline Y; Kowalik, S; Tsaltas, Margaret Owen; Ahmad, Raheela

2004-12-01

Although the risk of the eventual development of tardive dyskinesia and other persistent adverse effects of neuroleptics is high, among adults with mental retardation and other developmental disabilities, neuroleptics may ameliorate dyskinesias, aggression, and inattention. The effects of traditional neuroleptics on a comparable population of children and adolescents with mental retardation and other developmental disabilities are unknown. The objective of this study was to develop an assessment battery to describe the effects of traditional neuroleptics on the behavior and movements of a small sample of children and adolescents with mental retardation and other developmental disabilities. 13 children and adolescents aged 6 to 16 years attending a developmental disabilities clinic were evaluated utilizing a Movement Assessment Battery to measure behavior and motions. Five subjects took traditional neuroleptic medications. Trained raters can reliably assess the movements and behaviors of children and adolescents with multiple handicaps. Children and adolescents with developmental disabilities may be vulnerable to experience functional impairment and akathisia, tics, and other dyskinesias when administered traditional neuroleptic medications.

Obesity is not an independent risk factor for adverse perioperative and long-term clinical outcomes following open AAA repair or EVAR.

Science.gov (United States)

Park, Brian; Dargon, Phong; Binette, Christopher; Babic, Bruna; Thomas, Tina; Divinagracia, Thomas; Dahn, Michael S; Menzoian, James O

2011-10-01

Moderate (body mass index [BMI] ≥30) and morbid obesity (BMI ≥35) is increasing at an alarming rate in vascular surgery patients. The objective of this study was to determine the impact of obesity on perioperative and long-term clinical outcomes following open abdominal aortic aneurysm (AAA) repair or endovascular aneurysm repair (EVAR). This review includes patients that underwent open AAA repair (n = 403) or EVAR (n = 223) from 1999 to 2009. Specific patient characteristics such as comorbid diseases, medications, and body mass index (BMI) were assessed. Specific perioperative outcomes such as length of stay, myocardial infarctions, and mortality were reviewed. In addition, long-term outcomes such as rates of reintervention, permanent renal dysfunction, and mortality beyond 30 days were also assessed. The incidence of obesity in open AAA patients was 25.3% (documented incidence 1.5%) and for EVAR was 24.6% (documented incidence 4%). Moderate and morbid obesity was associated with longer intensive care unit (ICU) admissions for both open AAA or EVAR patients (P AAA repair or EVAR (P > .05). Similarly, moderate and morbid obesity was not associated with significant differences in rates of reintervention, permanent renal dysfunction, and mortality beyond 30 days for patients undergoing open AAA repair or EVAR (P > .05). The results of this study indicate that moderate and morbid obesity are not independently associated with adverse perioperative and long-term clinical outcomes for patients undergoing open AAA repair or EVAR. Therefore, either open AAA repair or EVAR can be accomplished safely in moderately obese and morbidly obese patients.

The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys.

Science.gov (United States)

Navarro-Mateu, F; Alonso, J; Lim, C C W; Saha, S; Aguilar-Gaxiola, S; Al-Hamzawi, A; Andrade, L H; Bromet, E J; Bruffaerts, R; Chatterji, S; Degenhardt, L; de Girolamo, G; de Jonge, P; Fayyad, J; Florescu, S; Gureje, O; Haro, J M; Hu, C; Karam, E G; Kovess-Masfety, V; Lee, S; Medina-Mora, M E; Ojagbemi, A; Pennell, B-E; Piazza, M; Posada-Villa, J; Scott, K M; Stagnaro, J C; Xavier, M; Kendler, K S; Kessler, R C; McGrath, J J

2017-07-01

While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. Lifetime occurrences of six types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ 2  = 190.1, P mental or general medical disorders. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quantifying Morbidity Burdens and Medical Utilization of Children with Intellectual Disabilities in Taiwan: A Nationwide Study Using the ACG Case-Mix Adjustment System

Science.gov (United States)

Lee, Wui-Chiang; Chen, Tzeng-Ji

2012-01-01

The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010…

Lunar phase does not influence perioperative complications in total hip arthroplasty.

Science.gov (United States)

Ficklscherer, Andreas; Angermann, Alexander; Weber, Patrick; Wegener, Bernd; Pietschmann, Matthias; Müller, Peter

2012-02-29

Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty. We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients' stay in the hospital and allocated them to moon illumination. There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase. Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase.

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

Science.gov (United States)

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

2017-10-01

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

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

African Journals Online (AJOL)

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

Canadian Disability Policies in a World of Inequalities

Directory of Open Access Journals (Sweden)

Deborah Stienstra

2018-05-01

Full Text Available Canadian disability-related policies are shaped within a global system of inequalities, including colonialism and neoliberalism. Using a critical theory framework, this article examines the complicated material inequalities experienced by people with disabilities and evident in the intersections of disability, gender, Indigenousness, race, and age. The collectively held ideas that give context to disability policies are at odds. Human rights protections are found in the foundational documents of Canadian society and part of its international commitments, yet these commitments often become window-dressing for a pervasive logic that it is better to be dead than disabled, and medical assistance in dying legislation supports this choice. While human rights protections are essential, they are not sufficient for decolonizing inclusion. Constructive actions between Indigenous peoples and settlers may help to find new ways of addressing disability and inclusion in Canada.

[Enhanced recovery after surgery based on medical ethics].

Science.gov (United States)

Zhao, Qingchuan

2016-03-01

Enhanced recovery after surgery (ERAS), a new model of perioperative management developed in recent years, can shorten hospital stay, reduce medical cost and postoperative discomfort. However, some of these measures under the strategy are negation of the traditional recommendation and many surgeons are concerned about the medical tangle by the complications coming with the ERAS strategy. In this paper, ERAS strategy is evaluated from an ethical standpoint and the assessment factors of medical behavior are introduced based on medical virtues and medical ethnics. It is also analyzed that how to deal with the conflicts between the textbooks and the ERAS strategy, and elaborated that the medical ethics should be observed if the ERAS strategy is implemented. The scientific principles must be followed, the rights and interests of the patients need to be protected, and the informed consent should be guaranteed.

Perioperative and postoperative complications of intracavitary radiation for FIGO stage I-III carcinoma of the cervix

International Nuclear Information System (INIS)

Jhingran, Anuja; Eifel, Patricia J.

2000-01-01

Purpose: To evaluate perioperative and postoperative complications of low-dose-rate (LDR) intracavitary radiation therapy in patients with FIGO Stage I-III carcinoma of the uterine cervix. Methods and Materials: We retrospectively reviewed the medical and radiotherapy records of all patients treated with radiation between 1960 and 1992 at The University of Texas M. D. Anderson Cancer Center for FIGO I-III carcinomas of the cervix. Patients who had had initial hysterectomy or whose treatment did not include intracavitary irradiation were excluded. The final study included 4043 patients who had undergone 7662 intracavitary procedures. Results: Eleven (0.3%) patients had documented or suspected cases of thromboembolism resulting in 4 deaths. Of these 11 patients, 8 had clinical or radiographic evidence of tumor involving pelvic nodes or fixed pelvic wall. The risk of postoperative thromboembolism did not decrease significantly with the routine use of mini-dose heparin prophylaxis (p = 0.3). Other life-threatening perioperative complications included myocardial infarction (1 death in 5 patients), cerebrovascular accident (2 patients), congestive heart failure or atrial fibrillation (3 patients), and halothane liver toxicity (2 deaths in 2 patients). Intraoperative complications included uterine perforation (2.8%) and vaginal laceration (0.3%), which occurred more frequently in patients ≥ 60 years old (p < 0.01). Fourteen percent of patients had a temperature ≥ 101 deg. F during at least one hospital stay. The only correlation between minor intraoperative complications and disease-specific survival was found in patients who had Stage III disease and uterine perforation; survival was significantly (p = 0.01) decreased in these patients. Conclusions: Fatal or life-threatening complications of intracavitary treatment were very rare. Deep venous thrombosis (DVT) and pulmonary embolism (PE) did not occur in otherwise healthy patients with early disease and were rare even

Implementation of Perioperative Music Using the Consolidated Framework for Implementation Research.

Science.gov (United States)

Carter, Jessica E; Pyati, Srinivas; Kanach, Frances A; Maxwell, Ann Miller W; Belden, Charles M; Shea, Christopher M; Van de Ven, Thomas; Thompson, Jillian; Hoenig, Helen; Raghunathan, Karthik

2018-06-12

Complementary integrative health therapies have a perioperative role in the reduction of pain, analgesic use, and anxiety, and increasing patient satisfaction. However, long implementation lags have been quantified. The Consolidated Framework for Implementation Research (CFIR) can help mitigate this translational problem. We reviewed evidence for several nonpharmacological treatments (CFIR domain: characteristics of interventions) and studied external context and organizational readiness for change by surveying providers at 11 Veterans Affairs (VA) hospitals (domains: outer and inner settings). We asked patients about their willingness to receive music and studied the association between this and known risk factors for opioid use (domain: characteristics of individuals). We implemented a protocol for the perioperative use of digital music players loaded with veteran-preferred playlists and evaluated its penetration in a subgroup of patients undergoing joint replacements over a 6-month period (domain: process of implementation). We then extracted data on postoperative recovery time and other outcomes, comparing them with historic and contemporary cohorts. Evidence varied from strong and direct for perioperative music and acupuncture, to modest or weak and indirect for mindfulness, yoga, and tai chi, respectively. Readiness for change surveys completed by 97 perioperative providers showed overall positive scores (mean >0 on a scale from -2 to +2, equivalent to >2.5 on the 5-point Likert scale). Readiness was higher at Durham (+0.47) versus most other VA hospitals (range +0.05 to +0.63). Of 3307 veterans asked about willingness to receive music, approximately 68% (n = 2252) answered "yes." In multivariable analyses, a positive response (acceptability) was independently predicted by younger age and higher mean preoperative pain scores (>4 out of 10 over 90 days before admission), factors associated with opioid overuse. Penetration was modest in the targeted subset (39

Disability Discrimination and Obesity: The Big Questions?

Science.gov (United States)

Flint, Stuart W; Snook, Jeremé

2015-12-01

Obesity discrimination in employment and recruitment has become a topic of focus for research examination with increasing reports of discrimination by colleagues and managers. Whilst a limited number of legal cases have emerged, disability law is consulted in line with the expectation of anti-discriminatory practices at work. In line with disability law, whether obesity is defined as a disability or not has an impact on the outcome of a court ruling. Ambiguity when defining obesity through either the medical or social model means there are many questions that remain unanswered which might lead to inconsistency in court rulings.

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

African Journals Online (AJOL)

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

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

African Journals Online (AJOL)

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

Disease-related effects of perioperative blood transfusions associated with 125I seed implantation for prostate carcinoma

International Nuclear Information System (INIS)

Petersen, J.P.; Schellhammer, P.F.; el-Mahdi, A.M.

1990-01-01

In some retrospective studies perioperative transfusions during oncologic surgery have been shown to decrease the time interval between surgery and local and/or distant recurrence of cancer. This study examines the disease-related effect, if any, of perioperative blood transfusions among 108 patients with localized carcinoma of the prostate treated by radioactive iodine-125 seed implantation of the prostate and lymphadenectomy. When all subjects were analyzed, there was no statistical difference of local and distant failure between the transfused and nontransfused groups. Patients with well-differentiated tumors had statistically fewer local recurrences (0% vs 22%, p = 0.036) if they were transfused perioperatively. However, the difference in distant metastases (0% vs 11%) was not statistically significant (p = 0.21). In contrast, patients with moderately and poorly differentiated disease receiving transfusions had more local recurrences and metastases, though this was not statistically significant. Our data suggest that there is no obvious evidence that perioperative blood transfusions have an adverse effect on local recurrence or distant metastases for iodine-125 seed implantation of carcinoma of the prostate

'Working is out of the question': a qualitative text analysis of medical certificates of disability.

Science.gov (United States)

Aarseth, Guri; Natvig, Bård; Engebretsen, Eivind; Lie, Anne Kveim

2017-04-20

specialist reports. Moreover, correct and coherent medical certificates can strengthen legal protection for claimants. Eventually, reducing advocacy in these documents may contribute to a fairer evaluation of whether claimants are eligible for disability benefits or not. Therefore, we believe that professional writing skills should be validated as an important part of medical practice and should be integrated in medical schools and in further education as a discipline in its own right, preferably involving humanities professors.

Concept of fast-track surgery and its application in perioperative period of hepatectomy for liver cancer

Directory of Open Access Journals (Sweden)

HAN Wei

2016-10-01

Full Text Available Fast-track surgery (FTS is widely used in the field of hepatopancreatobiliary surgery and has achieved a great success in the perioperative period of liver cancer. It has been recognized by clinical doctors and patients. This article introduces the concept of FTS, reviews its development, summarizes the detailed measures of FTS in the perioperative period of liver cancer and long-term application experience of FTS, and analyzes the current status of its clinical application. It is pointed out that when applied in the perioperative period of hepatectomy for liver cancer, FTS can reduce stress, lower the incidence of postoperative complications, shorten the length of hospital stay, and bring true benefits to patients.

Ethnic differences in disability risk between Dutch and Turkish scaffolders

NARCIS (Netherlands)

Elders, L.A.M.; Burdorf, A.; Öry, F.G.

2004-01-01

The number of native Dutch and Turkish workers receiving a permanent disability pension in the Netherlands is still rising. To assess ethnic differences in disability risk between Dutch and Turkish scaffolders, a retrospective study was conducted within a large scaffolding company. Medical files for

Making choices about medical interventions: the experience of disabled young people with degenerative conditions.

Science.gov (United States)

Mitchell, Wendy A

2014-04-01

Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. © 2012 John Wiley & Sons Ltd.

Analysis of disability due to spinal trauma in Ukraine in 2012

Directory of Open Access Journals (Sweden)

A. V. Ipatov

2013-12-01

Full Text Available Entry. Disability due to injuries of the musculoskeletal system in the past two decades is on the third place behind cardiovascular disease and cancer. Key indicators of disability are grooved by Medical Expert Commission of Ukraine in the annual analytical and informational governmental references, but lack data on disability due to spinal cord injury they include. Purpose. Examining the status of disability due to spinal injuries and spinal cord in 2012 in Ukraine. Materials and methods. In a specially designed program for the first time studied the state of disability due to spinal cord injury centers based on medical and social assessment in 24 regions of Ukraine, the Autonomous Republic of Crimea, Kiev and Sevastopol in 2012. Results. The total number of recognized initially disabled due to spinal cord injury was 2637 people, or 0.7 per 10,000 adult population. Repeatedly recognized as disabled - 11783 man, or 3.1 per 10,000 adult population. When comparing the level recognized as disabled by regions noted that it is higher in the "industrial" regions (Dnepropetrovsk, Donetsk, Kharkov regions. Indicators of disability due to spinal cord injury in the Ivano-Frankovsk region, far superior to those in other areas. Conclusions. In 2012, in Ukraine the primary disability due to spinal cord injuries totaled 2,637 persons or 0.7 per 10,000 adult population. In 2012 in Ukraine again as disabled due to spinal cord injury were 11783 people or 3.1 per 10,000 of adult population.

Disability approach in face of expansion of human rights

Directory of Open Access Journals (Sweden)

Joyceane Bezerra de Menezes

2016-12-01

Full Text Available It analyzes the social model of disability approach that is adopted by the Convention on the Rights of Persons with Disabilities. Unlike the medical model, disability shall be understood as the interaction between the limitation or natural deterrent suffering person in their physical functions, mental and / or intellectual and social barriers. The paper follows qualitative analysis, basing on bibliographical and documentary research that showed the change in paradigm of international documents on human rights, focusing on the inclusion of people with disabilities and mitigation of social barriers to participate in community life, social and politician.

Risk Factors for Perioperative Complications in Endoscopic Surgery with Irrigation

Directory of Open Access Journals (Sweden)

João Manoel Silva, Jr.

2013-07-01

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

Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge.

Science.gov (United States)

Zakaria, Mark A; Levy, Barbara S

2012-12-01

To present tactics for optimizing outpatient vaginal hysterectomy and describe perioperative outcomes in a large consecutive case series. This is a descriptive study and review of clinical outcomes in 1,071 patients selected to undergo vaginal hysterectomy for benign indications from 2000 to 2010. The setting is a single-surgeon private practice in a community hospital. Outcome measures include length of hospital stay, estimated blood loss, operative time, uterine weight, and perioperative complications, including hospital readmissions and emergency room visits. One thousand seventy-one of 1,162 cases (92%, 95% confidence interval [CI] 90.5-93.7) were total vaginal hysterectomies, of which 1,029 (96%, 95% CI 94.9-97.3) were discharged the same day after surgery. The median operative time was 34 minutes (range 17-210 minutes), and estimated blood loss was 45 mL (range 5-800 mL). The median patient age was 46 years (range 27-86 years), and median uterine weight was 160 g (range 25-1,380 g). One hundred ninety-three patients (18%, 95% CI 15.8-20.5) were nulliparous and 218 (20%, 95% CI 18-22.9) had prior pelvic surgery. Five patients (0.5%, 95% CI 0.2-1.1) required readmission or emergency room evaluation within the first 30 days. Vaginal hysterectomy can be successfully adopted as a same-day discharge procedure. In this population, regardless of previous pelvic surgery or nulliparity, good perioperative outcomes have been achieved.

Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy.

Science.gov (United States)

Akiyama, Yuji; Iwaya, Takeshi; Endo, Fumitaka; Shioi, Yoshihiro; Kumagai, Motoi; Takahara, Takeshi; Otsuka, Koki; Nitta, Hiroyuki; Koeda, Keisuke; Mizuno, Masaru; Kimura, Yusuke; Suzuki, Kenji; Sasaki, Akira

2017-12-01

We aimed to evaluate the effectiveness of intervention by a perioperative multidisciplinary support team for radical esophagectomy for esophageal cancer. We retrospectively reviewed 85 consecutive patients with esophageal cancer who underwent radical esophagectomy via right thoracotomy or thoracoscopic surgery with gastric tube reconstruction. Twenty-one patients were enrolled in the non-intervention group (group N) from May 2011 to September 2012, 31 patients in the perioperative rehabilitation group (group R) from October 2012 to April 2014, and 33 patients in the multidisciplinary support team group (group S) from May 2014 to September 2015. Morbidity rates were 38, 45.2, and 42.4% for groups N, R, and S, respectively. Although there were no significant differences in the incidence of pneumonia among the groups, the durations of fever and C-reactive protein positivity were shorter in group S. Moreover, postoperative oral intake commenced earlier [5.9 (5-8) days] and postoperative hospital stay was shorter [19.6 (13-29) days] for group S. The intervention by a perioperative multidisciplinary support team for radical esophagectomy was effective in preventing the progression and prolongation of pneumonia as well as earlier ambulation, oral feeding, and shortening of postoperative hospitalization.

The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study.

Science.gov (United States)

Mose, Louise S; Pedersen, Susanne S; Debrabant, Birgit; Jensen, Rigmor H; Gram, Bibi

2018-05-25

Factors associated with development of medication-overuse headache (MOH) in migraine patients are not fully understood, but with respect to prevention, the ability to predict the onset of MOH is clinically important. The aims were to examine if personality characteristics, disability and physical activity level are associated with the onset of MOH in a group of migraine patients and explore to which extend these factors combined can predict the onset of MOH. The study was a single-center prospective observational study of migraine patients. At inclusion, all patients completed questionnaires evaluating 1) personality (NEO Five-Factor Inventory), 2) disability (Migraine Disability Assessment), and 3) physical activity level (Physical Activity Scale 2.1). Diagnostic codes from patients' electronic health records confirmed if they had developed MOH during the study period of 20 months. Analyses of associations were performed and to identify which of the variables predict onset MOH, a multivariable least absolute shrinkage and selection operator (LASSO) logistic regression model was fitted to predict presence or absence of MOH. Out of 131 participants, 12 % (n=16) developed MOH. Migraine disability score (OR=1.02, 95 % CI: 1.00 to 1.04), intensity of headache (OR=1.49, 95 % CI: 1.03 to 2.15) and headache frequency (OR=1.02, 95 % CI: 1.00 to 1.04) were associated with the onset of MOH adjusting for age and gender. To identify which of the variables predict onset MOH, we used a LASSO regression model, and evaluating the predictive performance of the LASSO-mode (containing the predictors MIDAS score, MIDAS-intensity and -frequency, neuroticism score, time with moderate physical activity, educational level, hours of sleep daily and number of contacts to the headache clinic) in terms of area under the curve (AUC) was weak (apparent AUC=0.62, 95% CI: 0.41-0.82). Disability, headache intensity and frequency were associated with the onset of MOH whereas personality and the

Paradigms and mechanisms of inhalational anesthetics mediated neuroprotection against cerebral ischemic stroke

OpenAIRE

Wang, Hailian; Li, Peiying; Xu, Na; Zhu, Ling; Cai, Mengfei; Yu, Weifeng; Gao, Yanqin

2016-01-01

Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects...

Perioperative aspirin and clonidine and risk of acute kidney injury

DEFF Research Database (Denmark)

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

2014-01-01

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

Dexmedetomidine as an adjuvant for perioperative pain management in adolescents undergoing bariatric surgery: An observational cohort study.

Science.gov (United States)

Vaughns, Janelle D; Martin, Celeste; Nelson, Jonathon; Nadler, Evan; Quezado, Zenaide M

2017-11-01

The anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. To determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. An observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. While there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. These results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. Therapeutic, Level III. Copyright © 2017

Transcultural nursing in perioperative patient care.

Directory of Open Access Journals (Sweden)

Anna Kostka

2017-06-01

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

Pediatric Perioperative Pulmonary Arterial Hypertension: A Case-Based Primer

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Shilpa Shah

2017-10-01

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

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

Science.gov (United States)

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

2018-05-09

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

Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study.

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Atsushi Kimura

Full Text Available Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was performed just before the operation. Volumes of perioperative blood loss were compared with the results of detailed laboratory tests assessing primary hemostasis, secondary hemostasis, and fibrinolysis. Platelet aggregations induced by several agonists correlated with each other, and only two latent factors determined inter-individual difference. Platelet aggregability independently determined perioperative bleeding. We also identified low levels of plasminogen-activator inhibitor-1 (PAI-1 and α2-plasmin inhibitor to be independent risk factors for intraoperative and postoperative bleeding, respectively. Most important independent factor to determine postoperative bleeding was body weight. Of note, obese patients with low levels of PAI-1 became high-risk patients for bleeding during surgery. Our data suggest that bleeding after surgical procedure may be influenced by inter-individual differences of hemostatic function including platelet function and fibrinolysis, even in the patients without bleeding diathesis.

Perioperative incidents associated with internal maxillary distraction osteogenesis: a retrospective study of 20 patients.

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Kristian, Andersen; Erik, Nørholt Sven; Annelise, Küseler; John, Jensen; Klit, Pedersen Thomas

2012-12-01

This retrospective study aimed to assess the frequency and distribution of incidents encountered during the perioperative period of maxillary distraction with internal devices. The perioperative period was defined as the period between device placement and removal. Records of 20 patients treated during 2004-2011 with internal maxillary distraction osteogenesis were examined. Incidents were registered in terms of severity and need of intervention. Eighty percent of the patients experienced minor incidents, of which the most frequent were pain during activation and infections; 80% of these experienced ≥1 hard and soft tissue-related incidents, and 20% ≥1 device-related incidents. All incidents were solved with minimal or no intervention. Maxillary distraction using internal devices is a safe treatment with only minor incidents in the perioperative period. Preoperative planning and good cooperation are essential for preventing postoperative incidents. Prophylactic antibiotic treatment during the distraction period may be indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Battié, Renae N

2013-09-01

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

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

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Aliasgar V Moiyadi

2012-01-01

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

The P50 Research Center in Perioperative Sciences: How the investment by the National Institute of General Medical Sciences in team science has reduced postburn mortality.

Science.gov (United States)

Finnerty, Celeste C; Capek, Karel D; Voigt, Charles; Hundeshagen, Gabriel; Cambiaso-Daniel, Janos; Porter, Craig; Sousse, Linda E; El Ayadi, Amina; Zapata-Sirvent, Ramon; Guillory, Ashley N; Suman, Oscar E; Herndon, David N

2017-09-01

Since the inception of the P50 Research Center in Injury and Peri-operative Sciences (RCIPS) funding mechanism, the National Institute of General Medical Sciences has supported a team approach to science. Many advances in critical care, particularly burns, have been driven by RCIPS teams. In fact, burns that were fatal in the early 1970s, prior to the inception of the P50 RCIPS program, are now routinely survived as a result of the P50-funded research. The advances in clinical care that led to the reduction in postburn death were made by optimizing resuscitation, incorporating early excision and grafting, bolstering acute care including support for inhalation injury, modulating the hypermetabolic response, augmenting the immune response, incorporating aerobic exercise, and developing antiscarring strategies. The work of the Burn RCIPS programs advanced our understanding of the pathophysiologic response to burn injury. As a result, the effects of a large burn on all organ systems have been studied, leading to the discovery of persistent dysfunction, elucidation of the underlying molecular mechanisms, and identification of potential therapeutic targets. Survival and subsequent patient satisfaction with quality of life have increased. In this review article, we describe the contributions of the Galveston P50 RCIPS that have changed postburn care and have considerably reduced postburn mortality.

Work disability resulting from chronic health conditions.

Science.gov (United States)

Lerner, Debra; Allaire, Saralynn H; Reisine, Susan T

2005-03-01

To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. The authors conducted secondary data analysis and a literature review. Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. New research is urgently needed to reduce the burden of work disability on individuals and society.

Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

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Jochen Gille

2012-01-01

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

Perioperative nutritional status changes in gastrointestinal cancer patients.

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Shim, Hongjin; Cheong, Jae Ho; Lee, Kang Young; Lee, Hosun; Lee, Jae Gil; Noh, Sung Hoon

2013-11-01

The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (pgastric cancer patients, postoperative severe malnourishment increased significantly (p60, pgastric cancer (pgastric cancer, and open surgery remained significant as risk factors of severe malnutrition. The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.

Perioperative Complications in Patients With Sleep Apnea Undergoing Total Joint Arthroplasty.

Science.gov (United States)

Naqvi, Syed Y; Rabiei, Amin H; Maltenfort, Mitchell G; Restrepo, Camilo; Viscusi, Eugene R; Parvizi, Javad; Rasouli, Mohammad R

2017-09-01

This study aims to evaluate the effect of sleep apnea (SA) on perioperative complications after total joint arthroplasty (TJA) and whether the type of anesthesia influences these complications. Using the ninth and tenth revisions of the International Classification of Diseases, coding systems, we queried our institutional TJA database from January 2005 to June 2016 to identify patients with SA who underwent TJA. These patients were matched in a 1:3 ratio based on age, gender, type of surgery, and comorbidities to patients who underwent TJA but were not coded for SA. Perioperative complications were identified using the same coding systems. Multivariate analysis was used to test if SA is an independent predictor of perioperative complications and if type of anesthesia can affect these complications. A total of 1246 patients with SA were matched to 3738 patients without SA. Pulmonary complications occurred more frequently in patients with SA (1.7% vs 0.6%; P system complications and mortality (odds ratio = 15.88; 95% confidence interval, 3.93-64.07; P gastrointestinal complications, acute anemia, and mortality were lower in SA patients when regional anesthesia was used (P < .05). SA increases risk of postoperative pulmonary complications. The use of regional anesthesia may reduce risk of pulmonary complications and mortality in SA patients undergoing TJA. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospective study of use of perioperative antimicrobial therapy in general surgery.

LENUS (Irish Health Repository)

Fennessy, Brendan G

2012-02-03

BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

Rehabilitation time before disability pension.

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Støver, Morten; Pape, Kristine; Johnsen, Roar; Fleten, Nils; Sund, Erik R; Claussen, Bjørgulf; Ose, Solveig Osborg; Bjørngaard, Johan Håkon

2012-10-30

The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance. A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression. The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence. There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

Rehabilitation time before disability pension

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Støver Morten

2012-10-01

Full Text Available Abstract Background The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance. Methods A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression. Results The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence. Conclusions There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

Perioperative Interrogation of St. Jude Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists.

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Cronin, Brett; Essandoh, Michael K

2018-04-01

Feelings of trepidation or uncertainty regarding cardiovascular implantable electronic devices (CIEDs) in the perioperative period can often be mitigated by a thorough knowledge of societal recommendations, recommended management options, and familiarity with CIEDs. Given that effective interpretation of an interrogation report is vital to determining perioperative management options and applying societal recommendations, the creation and interpretation of St. Jude CIED interrogation reports are discussed. In an effort to increase the familiarity with St. Jude transvenous CIEDs amongst anesthesiologists, basic programming of a St. Jude pacemaker and implantable cardioverter defibrillator (ICD) also are described. Published by Elsevier Inc.

A Narrative Review: Actigraphy as an Objective Assessment of Perioperative Sleep and Activity in Pediatric Patients

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Nicole Conrad

2017-04-01

Full Text Available Sleep is an important component of pediatric health and is crucial for cognitive development. Actigraphy is a validated, objective tool to capture sleep and movement data that is increasingly being used in the perioperative context. The aim of this review is to present recent pediatric studies that utilized actigraphy in the perioperative period, highlight gaps in the literature, and provide recommendations for future research. A literature search was completed using OVID and PubMed databases and articles were selected for inclusion based on relevance to the topic. The literature search resulted in 13 papers that utilized actigraphic measures. Results of the review demonstrated that actigraphy has been used to identify predictors and risk factors for poor postoperative sleep, examine associations among perioperative pain and sleep patterns, and assess activity and energy expenditure in both inpatient and outpatient settings. We propose expansion of actigraphy research to include assessment of sleep via actigraphy to: predict functional recovery in pediatric populations, to study postoperative sleep in high-risk pediatric patients, to test the efficacy of perioperative interventions, and to assess outcomes in special populations for which self-report data on sleep and activity is difficult to obtain.

Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

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Anita Joselyn

2015-01-01

Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

A review of the peri-operative management of paediatric burns ...

African Journals Online (AJOL)

Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is ...

Perioperative high dose rate (HDR brachytherapy in unresectable locally advanced pancreatic tumors

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Brygida Białas

2011-07-01

Full Text Available Purpose: The aim of the study was to present an original technique of catheter implantation for perioperative HDR-Ir192 brachytherapy in patients after palliative operations of unresectable locally advanced pancreatic tumors and to estimate the influence of perioperative HDR-Ir192 brachytherapy on pain relief in terminal pancreatic cancer patients. Material and methods: Eight patients with pancreatic tumors located in the head of pancreas underwent palliative operations with the use of HDR-Ir192 brachytherapy. All patients qualified for surgery reported pain of high intensity and had received narcotic painkillers prior to operation. During the last phase of the surgery, the Nucletron® catheters were implanted in patients to prepare them for later perioperative brachytherapy. Since the 6th day after surgery HDR brachytherapy was performed. Before each brachytherapy fraction the location of implants were checked using fluoroscopy. A fractional dose was 5 Gy and a total dose was 20 Gy in the area of radiation. A comparative study of two groups of patients (with and without brachytherapy with stage III pancreatic cancer according to the TNM scale was taken in consideration. Results and Conclusions: The authors claim that the modification of catheter implantation using specially designed cannula, facilitates the process of inserting the catheter into the tumor, shortens the time needed for the procedure, and reduces the risk of complications. Mean survival time was 5.7 months. In the group of performed brachytherapy, the mean survival time was 6.7 months, while in the group of no brachytherapy performed – 4.4 months. In the group of brachytherapy, only one patient increased the dose of painkillers in the last month of his life. Remaining patients took constant doses of medicines. Perioperative HDR-Ir192 brachytherapy could be considered as a practical application of adjuvant therapy for pain relief in patients with an advanced pancreatic cancer.

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

Science.gov (United States)

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

2015-01-01

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

Empowerment of disability benefit claimants through an interactive website : Design of a randomized controlled trial

NARCIS (Netherlands)

Samoocha, D.; Bruinvels, D.J.; Anema, R.J.; Steenbeek, R.; Beek, A.J.V.D.

2009-01-01

Background. Individuals claiming a disability benefit after long-term sickness absence, have to undergo medical disability assessments. These assessments, often carried out by specialized physicians, can be complicated by wrong expectations or defensive attitudes of disability benefit claimants. It

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

Science.gov (United States)

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

2013-08-01

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

Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details?

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Zoia, Cesare; Bongetta, Daniele; Poli, Jacopo C; Verlotta, Mariarosaria; Pugliese, Raffaelino; Gaetani, Paolo

2017-01-01

This study intends to evaluate whether regional common habits or differences in case-volume between surgeons are significative variables in the perioperative management of patients undergoing surgery for lumbar disc herniation. An e-mail survey was sent to all neurosurgeons working in Lombardy, Italy's most populated region. The survey consisted of 17 questions about the perioperative management of lumbar disc herniation. Forty-seven percent (47%) out of 206 Lombard neurosurgeons answered the survey. Although in some respects there is clear evidence in current literature on which is the best practice to adopt for an optimal management strategy, we noticed substantial differences between respondents, not only between hospitals but also between surgeons from the same hospital. Still, no differences were evident in a high vs low case-volume comparison. We identified no regional clusterization as for practical principles in the perioperative management of lumbar disc herniation and neither was case-volume a significative variable. Other causes may be relevant in the variability between the perioperative management and the outcomes achieved by different specialists.

CAUSES OF VISUAL DISABILITY IN PATIENTS WITH VISUAL DISABILITY CERTIFICATES OBTAINED IN A TERTIARY CARE HOSPITAL IN MUMBAI

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Vikas Vijaykumar Kamat

2016-12-01

Full Text Available BACKGROUND Visual disability is a major public health problem in developing countries. Ocular diseases cause partial or total blindness. Causes can be treatable or non-treatable. Non-treatable causes lead to permanent visual disability. Persons with disabilities are given certificates mentioning percentage of disability after they demand certificates for various benefits. MATERIALS AND METHODS Records of the individuals who had been issued visual disability certificates during the period of 1 st March 2011 to 30 th June 2013 were obtained from Medical Records Office of the hospital and the information was analysed. RESULTS Out of 132 individuals with visual disability certificates, 97 were males and 35 were females. Avoidable causes of visual impairment were found in 43.18% individuals who were with corneal opacity, diabetic retinopathy, glaucoma, traumatic retinal detachment and postoperative retinal detachment. Unavoidable causes were found in 56.82% individuals who were with congenital diseases, optic nerve atrophy, hereditary causes, retinitis pigmentosa and age-related macular degeneration. Maximum numbers of individuals were issued certificates of 40% visual disability and least being 20% visual disability. Maximum number of individuals (48.49% demanded disability certificates for benefit in jobs. CONCLUSION High number of congenital diseases of eye explains the need of genetic counselling. Gender-based inequality for getting visual disability certificates should be minimised through awareness and education of people. Avoiding trauma to eyes can reduce the visual disability due to corneal scarring and infections in large extent. Early diagnosis and treatment is necessary to prevent blindness from avoidable causes like diabetic retinopathy, glaucoma and retinopathy of prematurity.

Digital health and perioperative care.

Science.gov (United States)

Fotis, Theofanis

2017-06-01

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

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

Science.gov (United States)

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

2017-07-01

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

20 CFR 404.1526 - Medical equivalence.

Science.gov (United States)

2010-04-01

... cases at the Administrative Law Judge or Appeals Council level, the responsibility for deciding medical....1526 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY... medical or psychological consultant employed or engaged to make medical judgments by the Social Security...

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

DEFF Research Database (Denmark)

Møller, M H; Adamsen, S; Thomsen, R W

2011-01-01

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

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing.

Science.gov (United States)

Fazal, M Ali; Bagley, Caroline; Garg, Parag

2018-02-01

The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p  0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p  0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05). Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Sumit Singh

2011-01-01

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

Melatonin in perioperative medicine: Current perspective

Directory of Open Access Journals (Sweden)

Souvik Maitra

2013-01-01

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

Brenna's story: A critical reflection and analysis of one mother's experience of navigating the medical system with a child with intellectual disabilities.

Science.gov (United States)

Bye, Amanda; Aston, Megan

2016-03-01

Children with intellectual disabilities spend more time in the health-care system than mainstream children. Parents have to learn how to navigate the system by coordinating appointments, understanding the referral process, knowing what services are available, and advocating for those services. This places an incredible amount of responsibility on families. This article is one mother's personal story and reflection about her journey through the Canadian health-care system in Nova Scotia, with her daughter who has an intellectual disability. The reflection identifies moments of tension experienced by a mother and how she was expected to be a medical system navigator, doctor-educator, time manager, and care coordinator and the roles that led to feelings of repression, extreme frustration, and fear. A final discussion offers an analysis of her experience, using concepts from feminist post-structuralism. © The Author(s) 2015.

Effect of age on the perioperative and radiographic complications of multilevel cervicothoracic spinal fusions.

Science.gov (United States)

Cloyd, Jordan M; Acosta, Frank L; Ames, Christopher P

2008-12-15

Retrospective review. To investigate the effect of age on the perioperative and radiographic complications associated with multilevel (>or=5) fusion of the cervicothoracic spine. Although the elderly comprise a substantial proportion of patients presenting with complex spinal pathology necessitating multilevel procedures across the cervical and cervicothoracic spine, the risk of perioperative and radiographic complications after these procedures is unknown. Between 2000 and 2007, 58 patients 65 years of age or older at a single institution underwent instrumented cervicothoracic spinal fusion of at least 5 levels. Fifty-eight patients under the age of 65 from the same time period served as a control group. A retrospective review of all hospital records, operative reports, radiographs, and clinic notes was conducted. Complications were classified as intraoperative, major and minor postoperative, and need for revision surgery. Flexion-extension radiographs were examined at discharge, 1.5, 6, 12 months, and then yearly, thereafter to evaluate fusion status and instrumentation-related complications. Principal diagnoses included spondylostenosis, malignancy, vertebral fracture, and osteomyelitis. Both groups were similar in number of levels fused (elderly, 6.7 +/- 2.1; control, 6.3 +/- 1.7) and circumferential procedures (27 vs. 28), respectively. There were no significant differences in operative time, blood loss, or length of hospital stay. Rates of intraoperative (5.2% vs. 3.4%), major (20.7% vs. 17.2%) and minor postoperative complications (27.6% vs. 22.4%), and reoperation (8.6% vs. 8.6%) were similar between the 2 groups. Utilization of a combined anterior-posterior fusion was associated with increased perioperative complications in the elderly on univariate but not multivariate analyses. Radiographic evidence of fusion was also comparable between the 2 groups. Perioperative complication rates of multilevel (>or=5) cervicothoracic spinal fusion in the elderly are

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.

Science.gov (United States)

Shim, Jae Kwang; Choi, Yong Seon; Oh, Young Jun; Bang, Sou Ouk; Yoo, Kyung Jong; Kwak, Young Lan

2007-07-01

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Disability research in the Nordic context – progress and challenges in investment welfare states 1970–2013

OpenAIRE

Roulstone, Alan

2013-01-01

Disability research and disability studies in the twenty-first century are almost unrecognisable compared to, for example, work that was completed on disability only 20–30 years ago. Disability research and disability studies may still be constructed as different entities: disability research shading into medical and rehabilitation studies, while disability studies is almost entirely concerned with the social aspects of disability. However, the terrain is now firmly stamped by the imprint of ...

Socioeconomic Factors and Work Disability: Clues to Managing Chronic Pain Disorder

Directory of Open Access Journals (Sweden)

Robert W Teasell

1999-01-01

Full Text Available Disability is a multifactorial phenomena in chronic pain disorders, as it is for other painful and nonpainful medical conditions. Socioeconomic factors are important determinants of disability, although this aspect of disability in chronic pain disorders is often ignored. Lower socioeconomic status has been shown to be associated with an increase in the frequency and severity of disability, and the rate of progression to disability in patients with chronic pain. Work disability in lower socioeconomic groups is associated with issues of physical work demands and work flexibility (ie, the ability to control the pace of work, take unscheduled breaks or engage in modified work. Workplace interventions, particularly in the subacute phase, that are geared to workers' limitations offer the best opportunity to reduce the current burden of disability. Where such work modifications are not available, disability will be problematic.

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

Science.gov (United States)

Papas, Anne; Caillard, Laurence; Nion, Nathalie

2011-01-01

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

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

Science.gov (United States)

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

2012-04-01

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

Impairment and disability rating in low back pain.

Science.gov (United States)

Katz, R T

2001-08-01

LBP is one of the two most common forms of disability in Western society (mental illness is the other), and remains a thorny problem in the arena of disability evaluation. Disability evaluation after LBP differs whether the pain is work-related or not. If work-related, guidelines for disability evaluation differ by jurisdiction and type of employment (e.g., private vs. federal employee). When outside of the workplace, thresholds for disability differ between entitlement programs (Social Security Disability) and private insurance programs (long-term disability insurance). In the patient without obvious findings, the disability evaluating physician needs to be caring and compassionate and yet maintain an objective stance with the understanding that there may be significant psychosocial overlay in patients with nonobjective pain complaints. Although some would argue that objective independent medical evaluation is an oxymoron, psychiatrists have excellent training and perspective with which to do so. The patient suffering from catastrophic brain injury or spinal cord injury offers a useful contrast--on the most severe end of the disability spectrum--to the patient with persisting low back complaints but normal physical examination. As a society, we have to wisely manage the funds that comprise our social "safety net" in order to provide for persons with severe disability who cannot provide for themselves. It would then follow that patients with minor impairments/disabilities should receive minor (i.e., noninflated) ratings. Psychiatrists need to enable rather than disable their patients.

Profiling health and health-related services for children with special health care needs with and without disabilities.

Science.gov (United States)

Houtrow, Amy J; Okumura, Megumi J; Hilton, Joan F; Rehm, Roberta S

2011-01-01

The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need. Secondary data analysis of the 2005-2006 National Survey of Children with Special Health Care Needs was conducted. The sociodemographics, health, and health services of CSHCN with and without disabilities were compared. Multivariable logistic regression was employed to examine factors associated with unmet need for health services. Children from minority racial and ethnic groups and children living in or near poverty were over-represented among CSHCN with disabilities, compared with other CSHCN. Statistically higher percentages of CSHCN with disabilities had behavioral problems (39.6% vs 25.2%), anxiety/depressed mood (46.1% vs 24.0%), and trouble making/keeping friends (38.1% vs 15.6%) compared with other CSHCN. Thirty-two percent of CSHCN with disabilities received care in a medical home compared with 51% of other CSHCN. CSHCN with disabilities had higher rates of need and unmet need than other CSHCN for specialty care, therapy services, mental health services, home health, assistive devices, medical supplies, and durable medical equipment. The adjusted odds of unmet need for CSHCN with disabilities were 71% higher than for other CSHCN. CSHCN with disabilities had more severe health conditions and more health services need, but they less commonly received care within a medical home and had more unmet need. These health care inequities should be amenable to policy and health service delivery interventions to improve outcomes for CSHCN with disabilities. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications

Science.gov (United States)

Roelants, Fabienne; Pospiech, Audrey; Momeni, Mona; Watremez, Christine

2016-01-01

The aim of this review is to summarize data published on the use of perioperative hypnosis in patients undergoing breast cancer surgery (BCS). Indeed, the majority of BCS patients experience stress, anxiety, nausea, vomiting, and pain. Correct management of the perioperative period and surgical removal of the primary tumor are clearly essential but can affect patients on different levels and hence have a negative impact on oncological outcomes. This review examines the effect of clinical hypnosis performed during the perioperative period. Thanks to its specific properties and techniques allowing it to be used as complementary treatment preoperatively, hypnosis has an impact most notably on distress and postoperative pain. During surgery, hypnosis may be applied to limit immunosuppression, while, in the postoperative period, it can reduce pain, anxiety, and fatigue and improve wound healing. Moreover, hypnosis is inexpensive, an important consideration given current financial concerns in healthcare. Of course, large randomized prospective studies are now needed to confirm the observed advantages of hypnosis in the field of oncology. PMID:27635132

Prevalence of Physical Disability and Accommodation Needs among Students in Physical Therapy Education Programs

Science.gov (United States)

Hinman, Martha R.; Peterson, Cathryn A.; Gibbs, Karen A.

2015-01-01

Most research on graduate students with disabilities (SWDs) has focused on medical education. The purposes of this study were to: (1) estimate the prevalence of students with physical disabilities (SWPDs) in physical therapy programs, (2) identify common types of physical disabilities, (3) document the types of accommodations requested by SWPDs,…

Self-expandable Metallic Stents Contribute to Reducing Perioperative Complications in Colorectal Cancer Patients with Acute Obstruction.

Science.gov (United States)

Furuke, Hirotaka; Komatsu, Shuhei; Ikeda, Jun; Tanaka, Sachie; Kumano, Tatsuya; Imura, Ken-Ichiro; Shimomura, Katsumi; Taniguchi, Fumihiro; Ueshima, Yasuo; Takashina, Ken-Ichiro; Lee, Chol Joo; Deguchi, Eiichi; Ikeda, Eito; Otsuji, Eigo; Shioaki, Yasuhiro

2018-03-01

The self-expandable metallic stent (SEMS) is an excellent non-invasive tool for emergent bowel obstruction. This study was designed to evaluate the clinical usefulness of the SEMS for avoiding perioperative complications. We analyzed a total of 47 consecutive patients who had a bowel obstruction due to colorectal cancer at initial diagnosis between 2012 and 2017 from hospital records. Perioperative complications occurred in 30% (14/47) of patients. Univariate and multivariate logistic regression analyses identified an age of more than 75 years [p=0.037, OR=6.84 (95% CI=1.11-41.6)] and the absence of an SEMS treatment [p=0.028, OR=18.5 (95% CI=1.36-250.0)] as independent risk factors for perioperative complications. Pneumonia (12.7% (6/47)) was the most common complication. There were no pneumonia patients (0% (0/15)) who were treated with the SEMS. In contrast to patients with the non-SEMS treatment, 18.7% (6/32) of all patients and 35.7% (5/14) of elderly patients had pneumonia. The SEMS is a safe and effective treatment for avoiding perioperative complications, particularly pneumonia, and may be a crucial strategy in elderly patients with acute obstruction due to colorectal cancer. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Just Looking and Staring Back: Challenging Ableism through Disability Performance Art

Science.gov (United States)

Eisenhauer, Jennifer

2007-01-01

This article advocates for art curriculum to be guided by the goal of challenging the discrimination, stigmatization, marginalization, and medicalization of disabled people. The Disability Arts Movement provides an important site through which to engage students in exploring the sociopolitical issue of ableism in art curriculum. The pedagogical…

[Perioperative management of Jehovah's Witness patients. Special consideration of religiously motivated refusal of allogeneic blood transfusion].

Science.gov (United States)

Habler, O; Voss, B

2010-04-01

The religious organization of Jehovah's Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah's Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah's Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah's Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah's Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism's natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

Disabled people in rural South Africa talk about sexuality.

Science.gov (United States)

McKenzie, Judith Anne

2013-01-01

Disability is emerging as a human rights issue of public concern, rather than an individual tragedy requiring medical attention. The issue of sexuality remains relatively neglected in this agenda, particularly as regards the exploration of the complexities of sexuality encountered by disabled people themselves. This paper focuses on the experiences of sexuality of disabled people and parents of disabled children in settings of poverty in the Eastern Cape Province of South Africa. Three individual interviews and two focus groups were conducted with disabled adults and parents of disabled children. Thematic analysis of the interviews identified three principal themes (1) sexuality development in the family of origin, (2) sexuality in the community and (3) adult sexuality and creating families. Each of these larger themes encompasses various sub-themes that are discussed in the findings. The paper concludes that while sexuality is a very difficult aspect of life for a disabled person due to myths and discrimination against disabled people, it is also an important arena for affirmation and establishing self-worth. It is therefore critical to consider the development of a healthy sexuality amongst disabled people and the promotion of their sexual rights.

Risk reduction: perioperative smoking intervention

DEFF Research Database (Denmark)

Møller, Ann; Tønnesen, Hanne

2006-01-01

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

Disability among patients with opioid use disorders and its relationship with stigma toward substance use

Directory of Open Access Journals (Sweden)

Saurabh Kumar

2018-01-01

Full Text Available Background: From a medical model perspective of substance use disorders (SUDs, opioid use disorders are associated with some degree of disability. This study aimed to assess the disability among patients with opioid use disorders (OUDs and its relationship with internalized stigma. Methodology: This cross-sectional study assessed patients with SUDs at a tertiary care center. Disability among patients with OUDs was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS while stigma was measured using Internalized Stigma of Mental Illness Scale (ISMIS. Results: Among 168 patients with OUD, the disability was greatest in the domain of work followed by interpersonal activities. About 48.2% and 3.0% of the participants had moderate and severe disability according to IDEAS. Disability (IDEAS scores had a robust correlation with the stigma (ISMIS scores (r = 0.453, P < 0.01. Multiple regression analysis found that internalized stigma (ISMIS score was an independent predictor of disability among patients with OUDs (β =0.42, P < 0.01. Conclusions: From a medical perspective, OUDs are associated with considerable disability which has significant correlation with internalized stigma. Designing interventions which can target internalized stigma among patients with OUD may help in reducing the disability associated with it.

Lived History of a Transformative Leader with a Disability: An Evocative Autoethnography for Social Justice

Science.gov (United States)

Vergara, Sofia

2017-01-01

Despite legal advancements recognizing the rights of individuals with disabilities, societal barriers are still arising from the medical model of disability. These obstacles have resulted in marginalizing and isolating practices, in turn leading to the underrepresentation of individuals with disabilities in the workforce and, by extension, in…

DISABILITY AND DEPRESSION AMONG HIGH UTILIZERS OF HEALTH-CARE - A LONGITUDINAL ANALYSIS

NARCIS (Netherlands)

VONKORFF, M; ORMEL, J; KATON, W; LIN, EHB

We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of

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

Science.gov (United States)

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

2008-10-01

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

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

African Journals Online (AJOL)

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

Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature?

Science.gov (United States)

Naspro, Richard; Lerner, Lori B; Rossini, Roberta; Manica, Michele; Woo, Henry H; Calopedos, Ross J; Cracco, Cecilia M; Scoffone, Cesare M; Herrmann, Thomas R; de la Rosette, Jean J; Cornu, Jean-Nicolas; DA Pozzo, Luigi F

2018-04-01

The number of patients on chronic anticoagulant or antiplatelet therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the perioperative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of bleeding versus thrombosis, and the important possible clinical and medical legal repercussions therein. Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge. The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high-risk group of patients, focusing on the perioperative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate, Thulium, Holmium and greenlight laser prostatectomy), bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial cancer, and nephrolithiasis. Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/high risk of coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight heparin can potentially lead to more bleeding than continuation of the anticoagulant(s) and antiplatelet therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team.

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

Science.gov (United States)

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

2016-03-01

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

ESTIMATION OF MULTI-MODAL ANALGESIA ADEQUACY IN THE PERIOPERATIVE PERIOD AT LONG-TERMED TRAUMATIZING ABDOMINAL OPERATIVE INTERVENTIONS

Directory of Open Access Journals (Sweden)

V. Kh. Sharipova

2015-01-01

Full Text Available PURPOSE OF THE STUDY. Improvement of perioperative multimodal analgesia at long­termed traumatizing abdominal interventions with estimation of its effectiveness.MATERIALS AND METHODS. Eighty six patients have been examined and divided into 3 groups depending on anesthesia and postoperative pain relief methods.RESULTS. The effectiveness of perioperative multi­modal analgesia using methods affecting the whole pathogenesis of pain has been revealed. Minimal stress of central and peripheral hemodynamics parameters, less evident pain syndrome in the post­operative period, economic effect shown up by the decrease of the use of narcotic analgesics both in intra­ and post­operative period have been observed.CONCLUSION. Algorithm of perioperative multi­modal analgesia at long­termed and traumatizing abdominal operative interventions has been developed. 

Age at Death in Individuals with Intellectual Disabilities.

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Arvio, Maria; Salokivi, Tommi; Bjelogrlic-Laakso, Nina

2017-07-01

We aimed to ascertain the average age at death (AD) in the intellectual disability population for each gender and compare them to those of the general population during 1970-2012. By analysing medical records, we calculated the ADs of all deceased clients (N = 1236) of two district organizations responsible for intellectual disability services. Statistics Finland's database generated data regarding ADs of all inhabitants who had died after having resided in same district. During the follow-up, average ADs for the intellectual disability population and general population increased, and simultaneously the AD difference between these populations decreased. In the 2000s, the AD difference between the intellectual disability population and the whole population was 22 years for men (95% CI: -24 to -20) and 30 years for women (95% CI: -33 to -27). In 2000s, the mean AD of those with mild-to-moderate intellectual disability (IQ 50-69) for women and men was 56 (SD17) and 54 (SD18), and those with severe to profound intellectual disability (IQ<50), 44 (SD23) and 43 (SD21). Intellectual disability is still a considerable risk factor for early death. Among the intellectual disability population, unlike in general population, the lifespans of women and men are equal. © 2016 John Wiley & Sons Ltd.

Chronic disease and disability among Iraqi populations displaced in Jordan and Syria.

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Doocy, Shannon; Sirois, Adam; Tileva, Margarita; Storey, J Douglas; Burnham, Gilbert

2013-01-01

The Iraq conflict resulted in the largest displacement in the Middle East since the Palestinian crisis, and provision of health services to the displaced population presents a critical challenge. The study aimed to provide information on chronic medical conditions and disability to inform humanitarian assistance planning. Nationally representative cross-sectional surveys of Iraqi populations displaced in Jordan and Syria were conducted in late 2008 and early 2009. Clusters of 10 household were randomly selected using probability-based sampling; a total of 1200 and 813 Iraqi households in Jordan and Syria, respectively, were interviewed. The majority of respondents in both countries perceived healthcare as unaffordable but accessible; cost was an important barrier to care. In Jordan, most routine health expenditures were for medications where in Syria, expenses were divided between medical consultations and medication. Chronic disease prevalence among adults was 51.5% (confidence interval (CI): 49.4-53.5) in Syria and 41.0% (CI: 39.4-42.7) in Jordan, most common were hypertension and musculoskeletal problems. Overall disability rates were 7.1% (CI: 6.3-8.0) in Syria and 3.4% (CI: 3.0-3.9) in Jordan. In both countries, the majority of disability was attributed to conflict, prevalence was higher in men than women, and depression was the leading cause of mental health disability. Chronic illnesses, disabilities and psychological health are key challenges for the Iraqi population and the health systems in Jordan and Syria. Continued attention to the development of systems to manage conditions that require secondary and tertiary care is essential, particularly given reported difficulties in accessing care and the anticipated prolonged displacement. Copyright © 2012 John Wiley & Sons, Ltd.

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

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Santosh Patel

2012-01-01

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

Coronary artery bypass grafting in a patient with protein S deficiency: Perioperative implications

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Baskaran Balan

2014-01-01

Full Text Available Protein S (PS along with activated protein C plays an important role in the down-regulation of in vivo thrombin generation. Its deficiency can cause abnormal and inappropriate clot formation within the circulation necessitating chronic anticoagulation therapy. The risk of developing thrombotic complications is heightened in the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB. Heparin resistance is very rare in these patients, especially when antithrombin levels are near normal. Management of CPB in this scenario is quite challenging. We report the perioperative management, particularly the CPB management, of a patient with type I PS deficiency and incidentally detected heparin resistance, who underwent coronary artery bypass grafting with CPB.

Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform.

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Hansen, Helena; Bourgois, Philippe; Drucker, Ernest

2014-02-01

In 1996 the U.S. severely restricted public support for low income people, ending "welfare as we know it." This led to dramatic increases in medicalized forms of support for indigent people, who increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their "disabled" status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor". Copyright © 2013 Elsevier Ltd. All rights reserved.

Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

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Xu C

2018-04-01

Full Text Available Can Xu, Mingqing Li, Chenggong Wang, Hui Li, Hua Liu Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China Purpose: Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery.Patients and methods: A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F, oral celecoxib (Group C, and buprenorphine transdermal delivery system (BTDS (Group BTDS. The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3.Results: The BTDS could effectively control perioperative pain for patients undergoing ­hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05 than that of the other two groups.Conclusion: The BTDS (a preemptive analgesia regimen could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation. Keywords: hallux valgus, buprenorphine transdermal

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

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

2012-08-01

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

[Perioperative transfusion of erythrocyte concentrates during elective surgery: introduction of a protocol for indications].

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Ortega Andrés, M C; Abad Gosálbez, A; López Sánchez, P; Martínez Aparisi, A; Ortí Lucas, R; Aranda Arrufat, A; Madrid Rondón, V

1999-10-01

The aim of this paper is, first, to know the actual situation of the perioperatory red cell transfusion for elective surgery in our hospital. In a second phase and prospectively, we tested guidelines for red cell perioperatory transfusion in order to observe the change of transfusions. Then, we compared the results between the basal and postintervention periods. We performed an aleatory assay with two periods, basal and interventionist. Basal period: 151 patients undergoing elective surgery with perioperatory blood requested and general anesthesia. Intervention period: We applied a transfusion guidelines protocol for perioperatory red cell transfusion from the Hospital's Transfusion Committee, also a questionnaire to evaluate the medical indication; We studied 164 patients with clinical features like the basal period. Study/results variables: preoperative blood request, perioperatively transfusion, number of packed red-cell units transfused, crossmatch--to--transfusion ratio, haemoglobin level pre and posttransfusion. No significant drop of the cross match-transfusion ratio was observed after intervention. There is a slight reduction of the crossmatch--to--transfusion ratio, although these value is high (4.48), due to an increase of the transfusion keeping the percentage of appropriate transfusions. The most frequent reason (53%) of inadequate transfusion is the active bleeding. 1) The transfusional activity of the Marina Alta Hospital supposes approximately 17% of the request and 6% of the global transfusion. 2) The introduction of a protocol of perioperative transfusion instructions suppose a small decrease of the crossmatch--to--transfusion ratio, without statistical significance. This slight reduction is due to an increase of transfusion in the post-intervention period, since in this period there is a group of older age patients and with greater percentage of associated pathology. 3) The rate of appropriate transfusions in both periods is similar. 4) The

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

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

2015-09-01

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

Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

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Jui-An Lin

Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

Monitoring of peri-operative fluid administration by individualized goal-directed therapy

DEFF Research Database (Denmark)

Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H

2007-01-01

BACKGROUND: In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess...

Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

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Tung-Yi Lin

2014-02-01

Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

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

2018-04-01

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

[Current concepts in perioperative management of children : preface and comments].

Science.gov (United States)

Kuratani, Norifumi; Kikuchi, Hirosato

2007-05-01

In the past few years, pediatric anesthesia management changed rapidly to more evidence-based and patient-oriented practice. It has been emphasized that "focused and individualized" pre-anesthesia evaluation is preferred to routine screening of laboratory tests and X-rays. Anesthesia induction should be less stressful for children through the use of various approaches, such as preoperative preparation, sedative premedication, and parent-present induction. Cuffed tracheal tube is becoming popular for small children, and its indication should be considered individually. Laryngeal mask airway is frequently used for simple short cases. Perioperative fluid infusion therapy has been a controversial issue. Traditional therapeutic regimen using hypotonic solution with glucose is criticized as a result of the growing evidence of hyponatremia and hyperglycemia. New ventilatory modes and sedative medications are now available for pediatric patients, and lung-protective ventilatory strategy should be considered to protect immature lung from ventilator-induced lung injury. Emergence agitation from general anesthesia is an evolving problem. Sevoflurane is known to be a major risk factor for stormy wake-up. Pediatric anesthesiologists should pursue high quality of anesthesia emergence. All anesthesia residency programs should include pediatric rotation; otherwise anesthesia residents will lose opportunities to learn basic concepts of pediatric anesthesia.

[Psychoprophylaxis in elective paediatric general surgery: does audiovisual tools improve the perioperative anxiety in children and their families?

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Álvarez García, N; Gómez Palacio, V; Siles Hinojosa, A; Gracia Romero, J

2017-10-25

Surgery is considered a stressful experience for children and their families who undergo elective procedures. Different tools have been developed to improve perioperative anxiety. Our objective is to demonstrate if the audiovisual psychoprophylaxis reduces anxiety linked to paediatric surgery. A randomized prospective case-control study was carried out in children aged 4-15 who underwent surgery in a Paediatric Surgery Department. We excluded patients with surgical backgrounds, sever illness or non-elective procedures. Simple randomization was performed and cases watched a video before being admitted, under medical supervision. Trait and state anxiety levels were measured using the STAI-Y2, STAI-Y2, STAI-C tests and VAS in children under 6-years-old, at admission and discharge. 100 patients (50 cases/50 controls) were included, mean age at diagnosis was 7.98 and 7.32 respectively. Orchiopexy was the most frequent surgery performed in both groups. Anxiety state levels from parents were lower in the Cases Group (36.06 vs 39.93 p= 0.09 in fathers, 38.78 vs 40.34 p= 0.43 in mothers). At discharge, anxiety levels in children aged > 6 were statistically significant among cases (26.84 vs 32.96, ppsychoprophylaxis tools shows a clinically relevant improvement in perioperative anxiety, both in children and their parents. Our results are similar to those reported by other authors supporting these tools as beneficial strategy for the family.

Applications for radio-frequency identification technology in the perioperative setting.

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Zhao, Tiyu; Zhang, Xiaoxiang; Zeng, Lili; Xia, Shuyan; Hinton, Antentor Othrell; Li, Xiuyun

2014-06-01

We implemented a two-year project to develop a security-gated management system for the perioperative setting using radio-frequency identification (RFID) technology to enhance the management efficiency of the OR. We installed RFID readers beside the entrances to the OR and changing areas to receive and process signals from the RFID tags that we sewed into surgical scrub attire and shoes. The system also required integrating automatic access control panels, computerized lockers, light-emitting diode (LED) information screens, wireless networks, and an information system. By doing this, we are able to control the flow of personnel and materials more effectively, reduce OR costs, optimize the registration and attire-changing process for personnel, and improve management efficiency. We also anticipate this system will improve patient safety by reducing the risk of surgical site infection. Application of security-gated management systems is an important and effective way to help ensure a clean, convenient, and safe management process to manage costs in the perioperative area and promote patient safety. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

[Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

Science.gov (United States)

Liu, Yan; Cui, Hu-jun; Tao, Liang; Chen, Xu-fa

2011-04-01

To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

Trajectories of life satisfaction five years after medical discharge for traumatically acquired disability.

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Hernandez, Caitlin L; Elliott, Timothy R; Berry, Jack W; Underhill, Andrea T; Fine, Philip R; Lai, Mark H C

2014-05-01

We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, burns, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition. (c) 2014 APA, all rights reserved.

Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff.

NARCIS (Netherlands)

Bekkema, N.; Veer, A.J.E. de; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

2014-01-01

Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs, ID physicians and care staff

NARCIS (Netherlands)

Bekkema, N.; de Veer, A.J.E.; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

2014-01-01

Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

Perioperative complications increase the risk of venous thromboembolism following bariatric surgery.

Science.gov (United States)

Helm, Melissa C; Simon, Kathleen; Higgins, Rana; Kindel, Tammy L; Gould, Jon C

2017-12-01

Morbidly obese patients are at increased risk of venous thromboembolism (VTE) following surgery. This study explores the impact of a perioperative complication on the risk of VTE after bariatric surgery. Patients who underwent bariatric surgery were identified from the American College of Surgeons National Surgical Quality Improvement Program dataset (2012-2014). The 17 most common perioperative complications were analyzed by multivariate regression analysis to determine the effect of complications on the risk of VTE. The postoperative incidence of VTE was 0.5% (n = 59,424 bariatric surgeries). The average time to diagnosis of VTE was 11.6 days. 80% of VTE events occurred after discharge. A major complication occurred prior to VTE in 22.6% of patients. The more complications experienced by an individual patient, the more likely they were to experience VTE. Unadjusted thirty-day mortality increased 13.89-fold following VTE (p bariatric surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist.

Science.gov (United States)

Christian, Eisha; Harris, Brianna; Wrobel, Bozena; Zada, Gabriel

2014-01-01

Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.

Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery

DEFF Research Database (Denmark)

Jørgensen, Mads E.; Sanders, Robert D.; Køber, Lars

2017-01-01

Aims Beta-blockers vary in pharmacodynamics and pharmacokinetic properties. It is unknown whether specific types are associated with increased perioperative risks. We evaluated perioperative risks associated with beta-blocker subtypes, overall and in patient subgroups. Methods and results We...... performed a Danish Nationwide cohort study, 2005-2011, of patients treated chronically with beta blocker (atenolol, bisoprolol, carvedilol, metoprolol, propranolol, or other) prior to non-cardiac surgery. Risks of 30-day all-cause mortality (ACM) and 30-day major adverse cardiovascular events (MACE) were...... in analyses stratified by age, surgery priority, duration of anaesthesia or surgery risk (all P for interaction >0.05). Conclusion Risks of ACM and MACE did not systematically differ by beta-blocker subtype. Findings may guide clinical practice and future trials....

Neuroanaesthetic and perioperative challenges in the management of giant encephaloceles

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V Bhatnagar

2013-01-01

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

Disability and health-related rehabilitation in international disaster relief

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Reinhardt, Jan D.; Li, Jianan; Gosney, James; Rathore, Farooq A.; Haig, Andrew J.; Marx, Michael; Delisa, Joel A.

2011-01-01

Background Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design Qualitative literature review and secondary data analysis. Results Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health

Children disability in Ukrainian provinces with population survived after the Chernobyl disaster

International Nuclear Information System (INIS)

Ipatov, A.V.; Sergieni, E.V.; Voitchak, T.G.; Pikush, A.Ya.

2004-01-01

Numerical characteristics and nosology structure of child disability of the age under 16 and disability from childhood following the Chernobyl accident was studied. The nosology structure of children disability showed the increased part of the specific diseases subject to causal connection of disability and consequences of the Chernobyl accident: malignant neoplasm of hemopoietic system, congenital malformations, and respiratory diseases. According to data from Ukrainian medical-social expert commissions there were neoplasm (29.4%), endocrine system diseases (19.6%, with thyroid diseases in 60%, mainly postoperative hypothyroidism), diseases of nervous system (11.0%), respiratory diseases (8.0%, with 99% of bronchial asthma), mental and behavioral disorders (5.0%) in the nosology structure of childhood disability in age older than 16

Tramadol hydrochloride/acetaminophen combination versus non-steroidal anti-inflammatory drug for the treatment of perioperative pain after total knee arthroplasty: A prospective, randomized, open-label clinical trial.

Science.gov (United States)

Mochizuki, Takeshi; Yano, Koichiro; Ikari, Katsunori; Hiroshima, Ryo; Takaoka, Hiromitsu; Kawakami, Kosei; Koenuma, Naoko; Ishibashi, Mina; Shirahata, Toshikatsu; Momohara, Shigeki

2016-09-01

While many of the commonly used treatments for perioperative pain after total knee arthroplasty (TKA) have been recognized as effective, there is still insufficient evidence for oral medication. In orthopedics, non-steroidal anti-inflammatory drugs (NSAIDs) have been commonly used for perioperative pain; however, serious adverse events have been reported. Conversely, tramadol hydrochloride/acetaminophen combination (TRAM/APAP) therapy has been shown to reduce pain, particularly for chronic pain in Japan. This study aimed to determine TRAM/APAP efficacy in comparison with NSAIDs for perioperative pain after TKA. Two hundred eighty patients were enrolled in this study; 137 patients were treated with TRAM/APAP, and 143 patients were treated with NSAID from postoperative (PO) day 2. The primary endpoint was a comparison between the pain visual analog scale (VAS) change from baseline (PO day 2) and PO day 4, day 7, day 10, and day 14. The second endpoint was the number of days until the patient achieved independence from cane walking. Analysis of endpoints included 130 and 139 patients in the TRAM/APAP and NSAID groups, respectively. The pain VAS change in the TRAM/APAP group on any of the measurement days was significantly improved compared with the NSAID group (P pain management after TKA of TRAM/APAP was shown to be superior to that of NSAID; TRAM/APAP was also effective in improving the progress of rehabilitation. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

The International Classification of Functioning, Disability and Health (ICF) and nursing.

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Kearney, Penelope M; Pryor, Julie

2004-04-01

Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses' thinking and practice by increasing awareness of the social, political and cultural dimensions of disability.

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

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

2017-03-01

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

Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

LENUS (Irish Health Repository)

Burke, Siun M

2010-04-01

Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

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Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

Adding Additional Acute Medications to a Triptan Regimen for Migraine and Observed Changes in Headache-Related Disability: Results From the American Migraine Prevalence and Prevention (AMPP) Study.

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Buse, Dawn C; Serrano, Daniel; Reed, Michael L; Kori, Shashi H; Cunanan, Cedric M; Adams, Aubrey Manack; Lipton, Richard B

2015-06-01

Though triptans are the most widely used acute treatments for migraine, response to treatment is sometimes suboptimal. Triptan therapy is often augmented by the addition of other acute treatments. The benefits of this practice have not been examined in large-scale, real-world observational studies. To assess changes in headache-related disability associated with adding additional acute treatments to a triptan regimen by category of added treatment including: a second triptan, nonsteroidal anti-inflammatory drugs (NSAID), opioids or barbiturates. Subjects were participants in the American Migraine Prevalence and Prevention study, a longitudinal, US population-based study of individuals with "severe" headache. Respondents who met International Classification of Headache Disorders 3 beta criteria for migraine were on triptan therapy per respondent self-report, used the same triptan, and provided headache-related disability data for at least 2 consecutive years. Subjects were divided based on headache days per month into 3 groups: low-frequency episodic migraine (LFEM, 0-4), moderate-frequency episodic migraine (MFEM, 5-9), and high-frequency episodic migraine/chronic migraine (HFEM/CM, ≥ 10 headache days per month). HFEM and CM were combined into a single group for analyses because of sample size limitations. Patterns of acute treatment for migraine were monitored from one year to the next over the following couplets of years (2005-2006, 2006-2007, 2007-2008, and 2008-2009). The first eligible couplet was analyzed for each respondent. Medication regimens studied included: (1) maintaining current triptan use (consistent group); (2) adding a different triptan; (3) adding an NSAID; or (4) adding a combination analgesic containing opioids or barbiturates. We assessed change in Migraine Disability Assessment (MIDAS) score from the first to the second year of a couplet, contrasting scores of participants with consistent use with those who added an acute treatment to

Transformation of Croatian Disabled Policy: Analysis of Policy Goals

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Ana Petek

2010-01-01

Full Text Available The article is based on the idea of transformation of the policy-making mode of Croatian disabled policy, from the medical model, through the social model to the human rights model. The paper highlights 7 elements according to which these models differ, and which are structured into categories of problem-definition, goal-determination and then implementation of disabled policy. The analysis is focused on the goals of Croatian disabled policy, and is based on an interdisciplinary research project of political science, special education and social work. Empirical data were collected by document analysis, by interviewing relevant policy actors and by a survey with the members of representative bodies on all government levels. With the discourse analysis of documents, open coding of interviews and statistical analysis of data collected in the survey, the paper attempts, through the indicator of activity of persons with disability, to answer to what extent Croatian disabled policy is transformed into human rights policy.

Coping experience of health concerns and physical disability for older Chinese people: A qualitative, descriptive study.

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Mei, He; Turale, Sue

2017-12-01

In this qualitative, descriptive study, we explored the perspectives of older, community-dwelling Chinese people regarding their experiences of coping with a physical disability and their health concerns. Twenty participants were interviewed in-depth, and data were analyzed using content analysis. Five themes with 13 subthemes emerged that described older people's experiences of coping with health concerns and disability: (i) ignoring health concerns; (ii) managing self; (iii) seeking medical help; (iv) living with physical disability; and (v) relying on limited resources. Most participants did not have sufficient access to health services due to physical disability and financial deficits, so they tended to ignore their health conditions or tackle them independently before seeking medical help. At the same time, they were impacted on by social and cultural factors. Policies are required that offer more resources to community-dwelling people with disabilities in China. © 2017 John Wiley & Sons Australia, Ltd.