WorldWideScience

Sample records for surgery care areas

  1. Standard guidelines of care for vitiligo surgery

    Directory of Open Access Journals (Sweden)

    Parsad Davinder

    2008-03-01

    Full Text Available Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. Facility: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. Indications for vitiligo surgery : Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. Preoperative counseling and Informed consent: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure

  2. Monitoring and improving care in thoracic surgery

    OpenAIRE

    Numan, R.C.

    2016-01-01

    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...

  3. Postoperative care in trichiasis surgery

    Directory of Open Access Journals (Sweden)

    Esmael Ali

    2016-10-01

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

  4. Palliative Care in Surgery: Defining the Research Priorities.

    Science.gov (United States)

    Lilley, Elizabeth J; Cooper, Zara; Schwarze, Margaret L; Mosenthal, Anne C

    2017-07-01

    Given the acute and often life-limiting nature of surgical illness, as well as the potential for treatment to induce further suffering, surgical patients have considerable palliative care needs. Yet, these patients are less likely to receive palliative care than their medical counterparts and palliative care consultations often occur when death is imminent, reflecting poor quality end-of-life care. Surgical patients would likely benefit from early palliative care delivered alongside surgical treatment to promote goal-concordant decision making and to improve patients' physical, emotional, social, and spiritual well-being and quality of life. To date, evidence to support the role of palliative care in surgical practice is sparse and palliative care research in surgery is encumbered by methodological challenges and entrenched cultural norms that impede appropriate provision of palliative care. The objective of this article was to describe the existing science of palliative care in surgery within three priority areas and expose specific gaps within the field. We propose a research agenda to address these gaps and provide a road map for future investigation.

  5. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn

    2013-01-01

    . The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care.Trial registration: Clinicaltrials.gov identifier: NCT01209663....

  6. Knowledge of intensive care nurses in selected care areas ...

    African Journals Online (AJOL)

    Knowledge of intensive care nurses in selected care areas commonly ... To assess the knowledge of nurses working in intensive care units (ICUs) in respect of pain management, ... An analytical, cross-sectional survey design was used.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  8. Glioma surgery in eloquent areas : can we preserve cognition?

    NARCIS (Netherlands)

    Satoer, Djaina; Visch-Brink, Evy; Dirven, Clemens; Vincent, Arnaud

    2015-01-01

    BACKGROUND: Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of e

  9. Glioma surgery in eloquent areas: can we preserve cognition?

    NARCIS (Netherlands)

    D.D. Satoer (Djaina); E.G. Visch-Brink (Evy); C.M.F. Dirven (Clemens); A. Vincent (Audrey)

    2016-01-01

    textabstractBackground: Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to t

  10. Glioma surgery in eloquent areas : can we preserve cognition?

    NARCIS (Netherlands)

    Satoer, Djaina; Visch-Brink, Evy; Dirven, Clemens; Vincent, Arnaud

    2015-01-01

    BACKGROUND: Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded due to the lack of

  11. Glioma surgery in eloquent areas: can we preserve cognition?

    NARCIS (Netherlands)

    D.D. Satoer (Djaina); E.G. Visch-Brink (Evy); C.M.F. Dirven (Clemens); A. Vincent (Audrey)

    2016-01-01

    markdownabstract__Background:__ Cognitive preservation is crucial in glioma surgery, as it is an important aspect of daily life functioning. Several studies claimed that surgery in eloquent areas is possible without causing severe cognitive damage. However, this conclusion was relatively ungrounded

  12. Continuum of Care (COC) Areas

    Data.gov (United States)

    Department of Housing and Urban Development — The purpose of the Continuum of Care (CoC) Homeless Assistance Programs is to reduce the incidence of homelessness in CoC communities by assisting homeless...

  13. Historical outline of oncologic surgery in the maxillofacial area

    Directory of Open Access Journals (Sweden)

    Christos MARTIS

    2012-04-01

    Full Text Available SUMMARY: The Father of Maxillofacial Surgery is General Surgery and not Oral Surgery, as it may seem from a clinical point of view. General Surgery was the precursor of the specialty of Maxillofacial Surgery since the era of the Hippocratics and up to the end of the 18th century and the begining of the 19th century, having as pioneers eminent general surgeons, such as Heister, von Graefe, C. Langenbeck, Syme, Dupuytren,Roux, Chassaignak, Hulihen, Mott, Billroth, B. Langen -beck, Kocher, Macewen, Albert, Broca, and others.The range of action of the a forementioned surgeons included mostly (in 80% of the cases surgical procedures in the maxillofacial area, mainly in the fields of Traumatology (facial fractures, Osteoplasty, reconstructive surgery (cleft lip and cleft palate operations,and the treatment of tumors.In the present article the historical elements connected with the roots of Oncologic Surgery in the maxillofacial area are outlined, an activity developed by the general surgeons of these eras, which are at the same time the pioneers of modern Maxillofacial Surgery.

  14. Nursing care for patients undergoing transoral robotic surgery.

    Science.gov (United States)

    Murray, Shannon

    2009-01-01

    Otorhinolaryngologists began developing new operative techniques to minimize open surgical resections of the head and neck. While striving to reduce the morbidity and mortality associated with head and neck surgery and decrease the many psychosocial issues facing these patients, a new procedure defined as Transoral Robotic Surgery (TORS) was developed. With the development of new surgical techniques, nursing care must also change to meet the needs of the patient. As the TORS procedure becomes fully defined, so is nursing's role in the care of the patient. This paper aims to define TORS and discuss the nursing care of the patient undergoing this new surgical procedure.

  15. Image-guided surgery and medical robotics in the cranial area.

    Science.gov (United States)

    Widmann, G

    2007-01-01

    Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area.

  16. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  17. Identification of Underserved Areas for Urologic Cancer Care

    Science.gov (United States)

    Mossanen, Matthew; Izard, Jason; Wright, Jonathan L.; Harper, Jonathan D.; Porter, Michael P.; Daratha, Kenn B.; Holt, Sarah K.; Gore, John L.

    2014-01-01

    BACKGROUND The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State. METHODS The authors accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2003 through 2007. They identified patients undergoing radical prostatectomy, radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy, and transurethral resection of the prostate (TURP). TURP was included for comparison as a reference procedure indicative of access to urologic care. Hospital service areas (HSAs) are where the majority of local patients are hospitalized; hospital referral regions (HRR) are where most patients receive tertiary care. The authors created multivariate hierarchical logistic regression models to examine patient and HSA characteristics associated with the receipt of urologic oncology care out of the HRR for each procedure RESULTS Greater than one-half of patients went out of their HRR in 7 HSAs (11%) for radical prostatectomy, 3 HSAs (5%) for radical nephrectomy, 10 HSAs (15%) for PN, and 14 HSAs (22%) for RC. No HSAs had high export rates for TURP. Few patient factors were found to be associated with surgical care out of the HRR. High-export HSAs for PN and RC exhibited lower socioeconomic characteristics than low-export HSAs, adjusting for HSA population, race, and HSA procedure rates for PN and RC. CONCLUSIONS Patients living in areas with lower socioeconomic status have a greater need to travel for complex urologic surgery. Consideration of geographic delineation in the delivery of urologic oncology care may aid in regional quality improvement initiatives. PMID:24523042

  18. Standard guidelines of care for acne surgery

    Directory of Open Access Journals (Sweden)

    Khunger Niti

    2008-03-01

    Full Text Available Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars. Physicians′ qualifications: Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers. Facility: Most acne surgery procedures can be performed in a physician′s minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting. Active acne: Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle. Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars. Cryotherapy: Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light, PDT (Photodynamic Therapy, pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars. Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the

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

    Science.gov (United States)

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

    2011-01-01

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

  20. Women's temporality after cardiac surgery: contributions to nursing care.

    Science.gov (United States)

    Amorim, Thais Vasconselos; Salimena, Anna Maria de Oliveira; Souza, Ívis Emília de Oliveira; de Melo, Maria Carmen Simões Cardoso; da Silva, Lúcia de Fátima; Cadete, Matilde Meire Miranda

    2015-01-01

    to unveil women's existential movement after cardiac surgery. qualitative phenomenological study. The research setting was a hospital in Minas Gerais, in which ten women were interviewed between December 2011 and January 2012. after hospital discharge, the women experienced physical, social and emotional impairments, and expressed the desire to go back to the time before their diagnosis, because they felt as though they still had heart disease. This vague and average understanding led to three units of meaning that, from a Heideggerian hermeneutic point of view, revealed the phenomenon of cardiac surgery as a present circumstance that limited the participants' daily lives. nurses supporting women patients after cardiac surgery should promote health considering existential facets that are expressed during care. The bases for comprehensive care are revealed in singular and whole meetings of subjectivity.

  1. Take Care of Yourself After an Amputation or Other Surgery

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery.  Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program.   Date Released: 2/18/2010.

  2. Monitored Anaesthesia Care (MAC in antalgic surgery

    Directory of Open Access Journals (Sweden)

    Giovanni Maria Pisanu

    2011-09-01

    Full Text Available The use of surgical techniques for pain relief in the treatment of chronic-persistent pain unresponsive to drug therapy is experiencing a growing spread application in algology. These techniques have set themselves the goal of removing the pain after treatment. Therefore, not always, percutaneous or open procedures are carried out with due precaution necessary to alleviate the patient discomfort and suffering during the surgical intervention. We present our personal experience in the use of this technique Monitored Anaesthesia Care (MAC for patients undergoing surgical treatment of pain management at our Regional Center of Pain Management.

  3. Innovation or rebranding, acute care surgery diffusion will continue.

    Science.gov (United States)

    Collins, Courtney E; Pringle, Patricia L; Santry, Heena P

    2015-08-01

    Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public or charity, and university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, and West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents' views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. We found a paradox between ACS viewed as a health care delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS because of increased desirability for trauma and critical care careers as well as improved EGS outcomes was tempered by fear over lack of continuity, poor institutional resources, and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers' diffusion of innovation theory. Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters. Published by Elsevier Inc.

  4. Primary care physician decision making regarding referral for bariatric surgery

    DEFF Research Database (Denmark)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild

    2017-01-01

    : Primary care physicians in Denmark. Methods: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions...... required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. Results: 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national...

  5. Surgery of the eloquent area using neuronavigation system

    Energy Technology Data Exchange (ETDEWEB)

    Nakai, Hirofumi; Tanaka, Tatsuya; Hashizume, Kiyotaka; Hodozuka, Akira [Asahikawa Medical Coll., Hokkaido (Japan)

    2001-09-01

    The efficacy of a neuronavigation system for surgery of lesions near Broca's area (6 patients), skull base (5 patients), or paracentral sulcus (10 patients) was evaluated in this study. Using the neuronavigation system, three-dimensional (3D) brain images were reconstructed by plotting cerebral sulcus obtained by MRI and CT. For paracentral sulcus lesions, patients underwent blood oxygen level-dependent fMRI while performing a finger-tapping motor paradigm. 3D reconstructed images were demonstrated to be useful for understanding the anatomical relationship between the lesions and the surrounding vital structures. The precentral gyri identified by 3D reconstructed brain images coincided well with that identified by fMRI. In lesions near Broca's area, skull base, and paracentral sulcus, 3D reconstructed brain images were very useful for both the preoperative surgical simulation and the intraoperative neuronavigation to preserve the postoperative neurological function and to perform less invasive surgery. (author)

  6. Need for Intensive Nutrition Care After Bariatric Surgery.

    Science.gov (United States)

    Bétry, Cécile; Disse, Emmanuel; Chambrier, Cécile; Barnoud, Didier; Gelas, Patrick; Baubet, Sandrine; Laville, Martine; Pelascini, Elise; Robert, Maud

    2017-02-01

    Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.

  7. General surgery 2.0: the emergence of acute care surgery in Canada

    Science.gov (United States)

    Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

    2010-01-01

    Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

  8. An investigation into the variability of primary care oral surgery contracts and tariffs in England and Wales (2014/2015).

    Science.gov (United States)

    Hierons, R J; Gerrard, G; Jones, R

    2017-06-09

    Primary care oral surgery services vary markedly throughout the country but until now there has been a paucity of data on these services. The British Association of Oral Surgeons (BAOS) primary care group (the authors) were tasked to gather data around primary care oral surgery contracts and tariffs and provide evidence-based recommendations on the commissioning of these services. Following a freedom of information (FOI) request, data were obtained for 27 English local area teams and seven Welsh local health boards. The data demonstrated both regional and national variability with respect to primary care oral surgery contracts, concerning both contract type and level of remuneration. These differences are discussed and the authors make recommendations for standardising oral surgery contracts and tariffs.

  9. Care initiation area yields dramatic results.

    Science.gov (United States)

    2009-03-01

    The ED at Gaston Memorial Hospital in Gastonia, NC, has achieved dramatic results in key department metrics with a Care Initiation Area (CIA) and a physician in triage. Here's how the ED arrived at this winning solution: Leadership was trained in and implemented the Kaizen method, which eliminates redundant or inefficient process steps. Simulation software helped determine additional space needed by analyzing arrival patterns and other key data. After only two days of meetings, new ideas were implemented and tested.

  10. OPC care-area feedforwarding to MPC

    Science.gov (United States)

    Dillon, Brian; Peng, Yi-Hsing; Hamaji, Masakazu; Tsunoda, Dai; Muramatsu, Tomoyuki; Ohara, Shuichiro; Zou, Yi; Arnoux, Vincent; Baron, Stanislas; Zhang, Xiaolong

    2016-10-01

    Demand for mask process correction (MPC) is growing for leading-edge process nodes. MPC was originally intended to correct CD linearity for narrow assist features difficult to resolve on a photomask without any correction, but it has been extended to main features as process nodes have been shrinking. As past papers have observed, MPC shows improvements in photomask fidelity. Using advanced shape and dose corrections could give more improvements, especially at line-ends and corners. However, there is a dilemma on using such advanced corrections on full mask level because it increases data volume and run time. In addition, write time on variable shaped beam (VSB) writers also increases as the number of shots increases. Optical proximity correction (OPC) care-area defines circuit design locations that require high mask fidelity under mask writing process variations such as energy fluctuation. It is useful for MPC to switch its correction strategy and permit the use of advanced mask correction techniques in those local care-areas where they provide maximum wafer benefits. The use of mask correction techniques tailored to localized post-OPC design can result in similar desired level of data volume, run time, and write time. ASML Brion and NCS have jointly developed a method to feedforward the care-area information from Tachyon LMC to NDE-MPC to provide real benefit for improving both mask writing and wafer printing quality. This paper explains the detail of OPC care-area feedforwarding to MPC between ASML Brion and NCS, and shows the results. In addition, improvements on mask and wafer simulations are also shown. The results indicate that the worst process variation (PV) bands are reduced up to 37% for a 10nm tech node metal case.

  11. [Evaluation of quality of care in a general surgery department].

    Science.gov (United States)

    Visset, J; Paineau, J; Letessier, E; Hamelin, E; Hamy, A; Courant, O

    A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

  12. Primary care teams work harder in deprived areas.

    Science.gov (United States)

    Carlisle, R; Avery, A J; Marsh, P

    2002-03-01

    The NHS Plan promises an equitable distribution of resources within primary care. To inform the debate on the extent to which resources should be redistributed we examined the association between primary care activity and deprivation. We used the natural experiment of the organization of primary care in Mansfield, Nottinghamshire, where town centre general practices have patients from electoral wards with a range of socio-economic characteristics who are subject to the same degree of supplier-induced demand and variations in data quality. We used one year's prospective data for two practices with 20,106 patients from 15 electoral wards. We performed linear regression analysis of directly age-standardized rates for different types of primary care activity and primary care morbidity-specific contacts against Townsend and Index of Multiple Deprivation 2000 scores. There were 44 per cent more out-of-hours contacts in more deprived areas (95 per cent confidence interval (CI) 17-70 per cent), 18 per cent more surgery consultations (95 per cent CI 8-27 per cent), and 28 per cent more same-day consultations (95 per cent CI 12-44 per cent). Routine visits by doctors and contacts by district and practice nurses did not have substantial associations with deprivation. Morbidity-specific contacts for psychological problems and respiratory problems were associated with deprivation but there was no significant association for contacts for low back pain, asthma or menopausal problems. Different types of primary care activity and contacts for different morbidities had different associations with deprivation. This makes it difficult to recommend a simple list size adjustment; however, increased activity in deprived wards needs to be recognized in resource allocation, service configuration and performance management in primary care.

  13. Decision support systems for robotic surgery and acute care

    Science.gov (United States)

    Kazanzides, Peter

    2012-06-01

    Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.

  14. [Nursing care in patients undergoing radiological surgery. A case report].

    Science.gov (United States)

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  15. Ibuprofen timing for hand surgery in ambulatory care

    Science.gov (United States)

    Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto

    2015-01-01

    OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

  16. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J;

    2015-01-01

    BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. REGISTRATION NUMBER: NCT01209663 (http://www.clinicaltrials.gov)....

  17. Patient safety in plastic surgery: identifying areas for quality improvement efforts.

    Science.gov (United States)

    Hernandez-Boussard, Tina; McDonald, Kathryn M; Rhoads, Kim F; Curtin, Catherine M

    2015-05-01

    Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

  18. Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

    Institute of Scientific and Technical Information of China (English)

    Aihuan Chen; Ronghua Ye; Yanchan Liu; Weici Liu; Jingyi Lin

    2014-01-01

    Purpose:To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children under-going cataract surgery. Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and re-ceived perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Results:Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anes-thetized without complications and underwent successful surgeries..No severe postoperative complications were ob-served. Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

  19. Surgery of the eloquent area using neuronavigation system

    Energy Technology Data Exchange (ETDEWEB)

    Nakai, Hirofumi; Tanaka, Tatsuya; Hashizume, Kiyotaka; Hodozuka, Akira; Ono, Hidetoshi; Goto, Takumi; Aburano, Tamio [Asahikawa Medical Coll., Hokkaido (Japan)

    2001-03-01

    The purpose of this minimally invasive study was to evaluate the efficacy of a neuronavigation system for surgery of lesions near Broca's area, skull base, or paracentral sulcus. With regards to paracentral sulcus lesions, precise localization of the precentral gyrus was evaluated not only with preoperative 3D images of the brain but also confirmed by the combination of fMRI and intraoperative SEP. Using the neuronavigation system, Viewing Wand (ISG Technologies), three-dimensional (3D) brain images were reconstructed by plotting cerebral sulcus and skull representations obtained by MRI and CT. Six patients with lesions near Broca's area, 5 patients with skull base lesions, and 9 patients with lesions near the central sulcus were analyzed. For paracentral sulcus lesions, patients underwent blood oxygen level-dependent fMRI while performing a finger-tapping motor paradigm, which was composed of repetition of rest-task every in 30 seconds for 150 seconds, in a 1.5-tesla echo-speed MR imager (Signa Horizon; General Electric Medical Systems, Milwaukee, WI). Statistical cross-correlation functional maps were generated and overlaid onto high-resolution anatomical MR images. Presurgical assessment of 3D reconstructed brain images were performed in all cases. They were analyzed in Broca's lesions, skull base lesions and paracentral sulcus lesions and were demonstrated to be useful for understanding the anatomical relationship between the lesions and the surrounding vital structures. In fMRI, motor activation sites were obtained on both ipsilateral and contralateral hemispheres in all patients except for one patient with a hemorrhagic cyst. Locations of precentral gyri were predicted preoperatively. In all patients except for one case, fMRI was obtained even in tumor patient in whom intraoperative SEP was technically not feasible due to severe cortical brain damage from the paracentral tumor. The precentral gyri identified by 3D reconstructed brain images

  20. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

    Directory of Open Access Journals (Sweden)

    Vester-Andersen Morten

    2013-02-01

    Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

  1. Development and Evaluation of Care Programs for the Delirium Management in Patients after Coronary Artery Bypass Graft Surgery (CABG

    Directory of Open Access Journals (Sweden)

    Safoora Fallahpoor

    2016-07-01

    Full Text Available Delirium is one of the common problems of cognitive impairment after coronary artery bypass graft surgery (CABG that its prevention, timely detection, and treatment require a care and management program to be controlled. The present research has studied a care program for the management of delirium in patients after coronary artery bypass graft surgery. This research was performed by action research methodology during a fivestage cycle in two groups of 50 persons (without interference and with intervention. In both groups, the patients were evaluated every 8 hours by CAM-ICU tool in hours (6, 14 and 22 for the occurrence of delirium after surgery until they were in Intensive Care Unit (ICU. In the intervention group, the developed program was implemented in three areas of delirium management before, during, and after the surgery. Then, the collected information was analyzed in two groups using descriptive and analytical statistics in SPSS 20 software. Delirium was observed at least once in 68% of patients without the intervention and 38% of patients with intervention after surgery. The ratio of delirium incidence was significantly lower in the intervention group (P<0.05. In addition, the total number of delirium in ICU was significantly lower for patients in the intervention group (P<0.05.The developed program for reducing the incidence of delirium in hospitalized patients after coronary artery bypass graft surgery (CABG was confirmed. This means that its applying will lead to a reduction in delirium.

  2. The consequences of obesity on trauma, emergency surgery, and surgical critical care

    Directory of Open Access Journals (Sweden)

    Velmahos George C

    2006-09-01

    Full Text Available Abstract The era of the acute care surgeon has arrived and this "new" specialty will be expected to provide trauma care, emergency surgery, and surgical critical care to a variety of patients arriving at their institution. With the exception of practicing bariatric surgeons, many general surgeons have limited experience caring for obese patients. Obese patients manifest unique physiology and pathophysiology, which can influence a surgeon's decision-making process. Following trauma, obese patients sustain different injuries than lean patients and have worse outcomes. Emergency surgery diseases may be difficult to diagnose in the obese patient and obesity is associated with increased complications in the postoperative patient. Caring for an obese patient in the surgical ICU presents a distinctive challenge and may require alterations in care. The following review should act as an overview of the pathophysiology of obesity and how obesity modifies the care of trauma, emergency surgery, and surgical critical care patients.

  3. Epilepsy Care in Ontario: An Economic Analysis of Increasing Access to Epilepsy Surgery

    Science.gov (United States)

    Bowen, James M.; Snead, O. Carter; Chandra, Kiran; Blackhouse, Gord; Goeree, Ron

    2012-01-01

    Background In August 2011 a proposed epilepsy care model was presented to the Ontario Health Technology Advisory Committee (OHTAC) by an Expert Panel on a Provincial Strategy for Epilepsy Care in Ontario. The Expert Panel recommended leveraging existing infrastructure in the province to provide enhanced capacity for epilepsy care. The point of entry for epilepsy care and the diagnostic evaluation for surgery candidacy and the epilepsy surgery would occur at regional and district epilepsy centres in London, Hamilton, Toronto, and Ottawa and at new centres recommended for northern and eastern Ontario. This economic analysis report was requested by OHTAC to provide information about the estimated budgetary impact on the Ontario health care system of increasing access to epilepsy surgery and to examine the cost-effectiveness of epilepsy surgery in both children and adults. Methods A prevalence-based “top-down” health care system budgetary impact model from the perspective of the Ministry of Health and Long-Term Care was developed to estimate the potential costs associated with expanding health care services to increase access to epilepsy care in general and epilepsy surgery in particular. A 5-year period (i.e., 2012–2016) was used to project annual costs associated with incremental epilepsy care services. Ontario Health Survey estimates of epilepsy prevalence, published epilepsy incidence data, and Canadian Census results for Ontario were used to approximate the number of individuals with epilepsy in the province. Applying these population estimates to data obtained from a recent field evaluation study that examined patterns of care and costs associated with epilepsy surgery in children, a health care system budget impact was calculated and the total costs and incremental costs associated with increasing access to surgery was estimated. In order to examine the cost-effectiveness of epilepsy surgery in children, a decision analysis compared epilepsy surgery to

  4. [Evaluation of practices of excisional therapies for CIN: An audit of surgery rooms from Marseilles' area].

    Science.gov (United States)

    Einaudi, L; Boubli, L; Carcopino, X

    2015-11-01

    To evaluate what is the proportion of surgery rooms from Marseilles' area that do perform excisional therapies for CIN without any use of colposcopic guidance. From November 2012 to January 2013, a survey was conducted among all surgery rooms from Marseilles' area practicing excisional therapies for CIN. In addition, answers from gynecologists from Marseilles' area who participated to a national survey that evaluated practices of excisional therapies in France were specifically analyzed. Among the 55 surgery rooms from Marseilles' area practicing excisional therapies, 52 (94.1%) participated to the current survey. A colposcope was available in only 19 (36.5%) surgery rooms and was systematically used for the guidance of excisional therapies in only 4 (21%) of these surgery rooms. Finally, 36 (69.2%) surgery rooms answered performing excisional therapies without any use of colposcopic guidance. Colposcopy was occasionally and systematically used in 12 (23.1%) and 4 (7.7%) surgery rooms, respectively. Among the 116 gynecologists from Marseilles' area who answered to the national survey, 88 (75.9%) answered not using colposcopy when performing excision for CIN. Only 6% answered performing excision systematically under direct colposcopic vision and 18.1% occasionally. No colposcopic guidance is used when performing excision for CIN in the majority of surgery rooms from Marseilles' area. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Day care surgery in a metropolitan government hospital setting--Indian scenario.

    Science.gov (United States)

    Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M

    2010-01-01

    Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.

  6. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2015-01-01

    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  7. Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.

    Science.gov (United States)

    Tekin, Fatma; Findik, Ummu Yildiz

    2015-01-01

    Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients.

  8. Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

    Science.gov (United States)

    Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

    2014-01-01

    High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

  9. The Surgery Innovation and Entrepreneurship Development Program (SIEDP): An Experiential Learning Program for Surgery Faculty to Ideate and Implement Innovations in Health care.

    Science.gov (United States)

    Servoss, Jonathan; Chang, Connie; Olson, David; Ward, Kevin R; Mulholland, Michael W; Cohen, Mark S

    2017-10-05

    Surgeons are continually engaged in the incorporation of new technologies in their practice. In the operating room and beyond, they combine technical skill with creative problem solving to improve tools and techniques for patient care, making them natural innovators. However, despite their innovative tendencies, education on entrepreneurship and commercialization is severely lacking. Moreover, with increasing pressure to meet productivity metrics, their availability to learn the complexities of commercialization is limited. To address these challenges, we designed the Surgery Innovation and Entrepreneurship Development Program (SIEDP) with the objective to advance faculty innovations, develop new departmental innovation initiatives, and improve faculty education in the area of innovation, entrepreneurship, and commercialization. The SIEDP is a first-of-its-kind experiential learning program specifically designed for busy clinical and research faculty in a major academic surgery department. Participants ideated and formed teams around health care innovations as they progressed through a 9-month curriculum of expert guest lectures and interactive workshops. A postprogram evaluation and outcome tracking method was used to evaluate attainment of educational objectives and project development milestones. The Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan. Eleven surgery faculty of varying academic rank and surgical subspecialties. The program generated 2 faculty startup companies, 1 departmental commercial product, 3 patent disclosures, and 3 innovations that received additional funding. All participants in the program reported a significant increase in their understanding of innovation and entrepreneurship and that participation was a worthwhile faculty development activity. Despite the various challenges and time constraints of surgical practices, programs like SIEDP can educate surgeons and other academicians on innovation

  10. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  11. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...

  12. The Plastic Surgery Compass: Navigating the Reconstructive Ladder in the Personalized Health Care Era.

    Science.gov (United States)

    Sandberg, Lars Johan M

    2016-09-01

    The reconstructive ladder and the reconstructive elevator have withstood the test of time as didactic tools for resident education. Over time, many alternative models have been suggested to incorporate the technological advances in plastic surgery, but none of them have focused on the patient. Changes in practice and the trend toward personalized health care demand a 360-degree evaluation and solution of surgical problems incorporating patient-specific characteristics. We, therefore, suggest the concept of the plastic surgery compass to navigate the ladder.

  13. Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery.

    Science.gov (United States)

    Wei, Holly; Roscigno, Cecelia I; Swanson, Kristen M

    Parents of children with congenial heart disease (CHD) face frequent healthcare encounters due to their child's care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents' perceptions of healthcare providers' actions when their child undergoes heart surgery. To describe parents' perceptions of healthcare providers' actions when their child is diagnosed with CHD and undergoes heart surgery. This is a qualitative study with in-depth interviews. Parents of children with CHD were interviewed twice after surgery. We analyzed data using directed content analysis guided by Swanson Caring Theory. Findings of the study indicate that parents perceive caring when providers seek to understand them (knowing); accompany them physically and emotionally (being with); help them (doing for); support them to be the best parents they can be (enabling); and trust them to care for their child (maintaining belief). Healthcare providers play an irreplaceable role in alleviating parents' emotional toll when their child undergoes cardiac surgery. Providers' caring is an integral component in healthcare. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  15. Colonic surgery with accelerated rehabilitation or conventional care

    DEFF Research Database (Denmark)

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

    2004-01-01

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

  16. The Affordable Care Act: implications for cardiothoracic surgery.

    Science.gov (United States)

    Ferguson, T Bruce; Babb, Joseph A

    2013-01-01

    The Affordable Care Act legislation that was passed by the US Congress and signed into law by President Obama on March 23, 2010 is having a substantial effect throughout all of health care in the United States. Cardiothoracic surgeons, as hospital-based procedural specialists, bring unique assets and certain important liabilities into this massive restructuring of our health care delivery system. This article highlights how each of the 10 titles in the Obamacare legislation might affect our specialty; its collaborative relationship with our cardiovascular, medical specialty, and primary care colleagues; and our clinical practice roles and responsibilities in accountable care organizations and primary care medical homes. This article also addresses the unique assets in clinical data in medicine and quality improvement demonstrated by our specialty that have been used to help shape the current and future landscape. Finally, key resources are identified to allow the cardiothoracic community to monitor the ongoing progress of Obamacare as implementation begins. Keeping abreast of these rapidly changing developments will be an important role for our specialty societies and for practitioners alike going forward.

  17. Pursuing bariatric surgery in an urban area: Gender and racial disparities and risk for psychiatric symptoms.

    Science.gov (United States)

    Miller-Matero, Lisa Renee; Tobin, Erin T; Clark, Shannon; Eshelman, Anne; Genaw, Jeffrey

    2016-01-01

    Bariatric surgery is effective for weight loss; however, only a small percentage of those who qualify choose to pursue it. Additionally, although psychiatric symptoms appear to be common among candidates, the risk factors for symptoms are not known. Therefore, the purpose of this study was to examine the characteristics of those who are pursuing bariatric surgery in an urban area, whether demographic disparities continue to exist, and identify characteristics of those who may be at higher risk for experiencing psychiatric symptoms. There were 424 bariatric candidates who completed a required psychological evaluation prior to bariatric surgery. Bariatric surgery candidates tended to be middle-aged, Caucasian females, which was unexpected when compared to the rates of obesity among these groups. Therefore, it appears that there are disparities in who chooses to seek out bariatric surgery compared to those who may qualify due to their obesity status. Cultural factors may play a role in why males and African Americans seek out bariatric surgery less frequently. Psychiatric symptoms among candidates are also common, with depression symptoms increasing with age and BMI. Perhaps the compounding effects of medical comorbidities over time are contributing to greater depressive symptoms in the older patients. Findings from this study suggest that we may need to explore ways of encouraging younger patients, males, and ethnic minorities to pursue bariatric surgery to increase weight loss success and decrease medical comorbidities. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2017-04-01

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

  19. Day surgery: Are we transferring the burden of care?

    African Journals Online (AJOL)

    2013-11-25

    Nov 25, 2013 ... in the recovery room post procedure and discharged to the wards after ... a healthcare provider with a complaint directly linked to the operation. .... a transfer of care as this service would still be required were the patient to be ...

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

    OpenAIRE

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

    2014-01-01

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

  1. Robotic surgery in urological oncology: patient care or market share?

    Science.gov (United States)

    Kaye, Deborah R; Mullins, Jeffrey K; Carter, H Ballentine; Bivalacqua, Trinity J

    2015-01-01

    Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.

  2. Perioperative complications of cardiac surgery and postoperative care.

    Science.gov (United States)

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

    2014-07-01

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

  3. Point of care investigations in pediatric care to improve health care in rural areas.

    Science.gov (United States)

    Walia, Kamini

    2013-07-01

    The good quality laboratory services in developing countries are often limited to major urban centers. As a result, many commercially available high-quality diagnostic tests for infectious diseases are neither accessible nor affordable to patients in the rural areas. Health facilities in rural areas are compromised and this limits the usability and performance of the best medical diagnostic technologies in rural areas as they are designed for air-conditioned laboratories, refrigerated storage of chemicals, a constant supply of calibrators and reagents, stable electrical power, highly trained personnel and rapid transportation of samples. The advent of new technologies have allowed miniaturization and integration of complex functions, which has made it possible for sophisticated diagnostic tools to move out of the developed-world laboratory in the form of a "point of care"(POC) tests. Many diagnostic tests are being developed using these platforms. However, the challenge is to develop diagnostics which are inexpensive, rugged and well suited to the medical and social contexts of the developing world and do not compromise on accuracy and reliability. The already available POC tests which are reliable and affordable, like for HIV infection, malaria, syphilis, and some neglected tropical diseases, and POC tests being developed for other diseases if correctly used and effectively regulated after rigorous evaluation, have the potential to make a difference in clinical management and improve surveillance. In order to use these tests effectively they would need to be supported by technically competent manpower, availability of good-quality reagents, and healthcare providers who value and are able to interpret laboratory results to guide treatment; and a system for timely communication between the laboratory and the healthcare provider. Strengthening the laboratories at the rural level can enable utilization of these diagnostics for improving the diagnosis and management of

  4. Care of the breastfeeding mother in medical-surgical areas.

    Science.gov (United States)

    Wenner, Lori

    2007-04-01

    Benefits and myths of breastfeeding may interfere with the breastfeeding relationship during maternal hospitalization. Guidelines for maintaining the breastfeeding relationship and/or protecting the milk supply during contact with the health care system outside of the maternal child area are presented.

  5. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... treatment, such as physical therapy following a non-covered surgical procedure in an MTF. It would also... treatment, are excluded and could result in less than optimal care (e.g., not receiving necessary physical therapy following surgery) and/or a significant financial hardship for the beneficiary. The Agency did not...

  6. 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.

  7. Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

    NARCIS (Netherlands)

    Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.

    2010-01-01

    OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical

  8. Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

    NARCIS (Netherlands)

    Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.

    2010-01-01

    OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical

  9. The transforming power of early career acute care surgery research scholarships on academic productivity.

    Science.gov (United States)

    Zarzaur, Ben L; Valsangkar, Nakul; Feliciano, David F; Koniaris, Leonidas G

    2016-07-01

    More than 75% of respondents to an Eastern Association for the Surgery of Trauma survey felt that barriers to research had increased and that acute care surgeon (ACS) academic productivity had decreased. Recent data confirm this impression and show lower academic productivity of junior ACS faculty compared with peers in other general surgical fields. The purpose of this study was to determine if early career acute care surgery research scholarships are associated with improved ACS academic productivity. Faculty data at the Top 55 National Institutes of Health (NIH)-funded departments of surgery (Top 55) were obtained using SCOPUS, NIH, department, and professional society databases. Academic productivity was measured using total publications, citations, and the Hirsch index. Scholarship recipients from the American Association for the Surgery of Trauma and Eastern Association for the Surgery of Trauma were identified. A total of 4,101 surgical faculty (8.3% ACS) who belong to the Top 55 NIH-funded departments of surgery and 85 scholarship recipients were identified. After merging, 34 scholarship recipients (40%) were current faculty at a Top 55 NIH-funded department of surgery, and 24 of those (71%) were ACS faculty. Scholarship recipients had higher median total publications compared with nonrecipients at assistant and associate ranks but not at full professor rank. For all ranks, scholarship recipients were more likely to have NIH funding compared with nonrecipients (33% vs. 11%, p publications, with an average of 89 more publications over a career (p ACS faculty in Top 55 NIH-funded departments of surgery. Among junior ACS faculty, recipients are associated with increased academic productivity and NIH funding. To fill the academic productivity gap among junior ACSs, professional organizations should consider increasing research funding scholarships for promising investigators.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  11. Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention

    Science.gov (United States)

    Senthuran, Siva; Blakely, Brette; Lane, Paul; North, John; Clay-Williams, Robyn

    2017-01-01

    Introduction Patients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians. Methods and analysis After being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience. Ethics and dissemination This study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal. PMID:28242771

  12. Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention.

    Science.gov (United States)

    Selwood, Amanda; Senthuran, Siva; Blakely, Brette; Lane, Paul; North, John; Clay-Williams, Robyn

    2017-02-27

    Patients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians. After being assessed for frailty, patients will complete a patient-clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience. This study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal. 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/.

  13. Global Surgery Fellowship: A model for surgical care and education in resource-poor countries.

    Science.gov (United States)

    Aarabi, Shahram; Smithers, Charles; Fils, Marie-May Louis; Godson, Jean-Louis; Pierre, Jean-Hamilton; Mukherjee, Joia; Meara, John; Farmer, Paul

    2015-10-01

    Surgical diseases have recently been shown to be a major cause of global morbidity and mortality. Effective methods to decrease the burden of surgical disease and provide care in resource-poor settings are unknown. An opportunity to meet this need exists through collaborative efforts to train local surgeons in specialty care, such as pediatric general surgery. We present a novel model for the provision of surgical care and education in a resource-poor setting via a collaborative Global Surgery Fellowship program. Through Partners in Health in Haiti, this program placed a fully trained pediatric surgeon at an established rural hospital, both to temporarily serve that community and to teach local surgeons pediatric surgical care. The Global Surgery Fellow performed the cases presented here during his term, between July 2009 and June 2010. A total of 147 operative procedures were performed on 131 patients over the course of 12 weeks in Haiti. A total of 134 of the 147 total cases performed (91.2%) were educational cases, in which the Fellow operated with and trained one or more of the following: American medical students, American residents, Haitian residents, or Haitian staff surgeons. The Global Surgery Fellowship model overcomes many of the traditional challenges to providing adequate surgical care in resource-poor countries. Specifically, it meets the challenge of providing a broad educational experience for many levels of local and foreign physicians, while working within an established locally run health care system. We believe that this model is generalizable to many resource-poor hospitals with permanent local staff that are open to collaboration. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Problems in the educational process during the pediatric surgery area teaching of fourth year medicine students

    Directory of Open Access Journals (Sweden)

    Sergio Luis González López

    2011-04-01

    Full Text Available Very typical situations of the Pediatric Surgery Services in the Pediatric Hospital of Cienfuegos may interfere with the appropriate development of the educational process. Consequently, students might not master the principles of medical practice in the most common surgical diseases in children, thus limiting its further application in their professional performances as basic general practitioners. To obtain more accurate information on the causes of this phenomenon is considered to be paramount in order to search for practical solutions to improve the educational process and to fulfil the goals of the teaching stage. The contents on the following information sources are analyzed in this paper: documents for higher education and for medicine career, publications and papers presented in scientific events (directly or indirectly related to the practice of Pediatric Surgery and hospital statistics. This review was aimed at analyzing the situations that negatively affect the educational process during the pediatric surgery area teaching of fourth year medicine students.

  15. Day-care hypospadias surgery: Single surgeon experience

    Directory of Open Access Journals (Sweden)

    Chandrasekharam V.V.S.S

    2007-01-01

    Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.

  16. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery.

    Science.gov (United States)

    Larjani, Soroush; Spivak, Israel; Hao Guo, Ming; Aliarzadeh, Babak; Wang, Wei; Robinson, Sandra; Sockalingam, Sanjeev; Aarts, Mary-Anne

    2016-02-01

    Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low. To identify patient factors that contribute to adherence to follow-up care after bariatric surgery. Three university-affiliated hospitals in Canada A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients' socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent. The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017). Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Enhanced recovery after elective colorectal surgery: now the standard of care.

    LENUS (Irish Health Repository)

    Andrews, E J

    2011-09-01

    Enhanced recovery programmes have been studied in randomised trials with evidence of quicker recovery of gut function, reduced morbidity, mortality and hospital stay and improved physiological and nutritional outcomes. They aim to reduce the physiological and psychological stress of surgery and consequently the uncontrolled stress response. The key elements, reduced pre-operative fasting, intravenous fluid restriction and early feeding after surgery, are in conflict with traditional management plans but are supported by strong clinical evidence. Given the strength of the current data enhanced recovery should now be the standard of care.

  18. The Plastic Surgery Compass: Navigating the Reconstructive Ladder in the Personalized Health Care Era

    Science.gov (United States)

    2016-01-01

    Summary: The reconstructive ladder and the reconstructive elevator have withstood the test of time as didactic tools for resident education. Over time, many alternative models have been suggested to incorporate the technological advances in plastic surgery, but none of them have focused on the patient. Changes in practice and the trend toward personalized health care demand a 360-degree evaluation and solution of surgical problems incorporating patient-specific characteristics. We, therefore, suggest the concept of the plastic surgery compass to navigate the ladder. PMID:27757348

  19. Sepsis following cancer surgery: the need for early recognition and standardised clinical care.

    Science.gov (United States)

    Hiong, A; Thursky, K A; Teh, B W; Haeusler, G M; Slavin, M A; Worth, L J

    2016-01-01

    Despite the implementation of multimodal bundles of care in hospitalised patients, post-operative sepsis in patients with cancer still accounts for a significant burden of illness and substantial healthcare costs. Patients undergoing surgery for cancer are at particular risk of sepsis due to underlying malignancy, being immunocompromised associated with cancer management and the complexity of surgical procedures performed. In this review, we evaluate the burden of illness and risks for sepsis following surgery for cancer. Current evidence supporting standardised strategies for sepsis management (including early recognition and resuscitation) is examined together with challenges in implementing quality improvement programs.

  20. Surgery in Brazilian Health Care: funding and physician distribution.

    Science.gov (United States)

    Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario

    2017-01-01

    to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a

  1. 左半肝切除术的护理%Left liver resection careSurgery

    Institute of Scientific and Technical Information of China (English)

    唐成毅

    2015-01-01

    Objective To investigate the left liver resection patient care, summarize nursing experience, reduce complications. Methods Our department in January 2013 --2015 January pancreas left hepatectomy in patients after surgery care cases 32 cases, from lessons learned.Results Our department 32 cases left hepatectomy patient had complications, and achieved satisfactory results. Conclusion Strengthening careful observation of the disease after surgery and intensive care to improve the success rate of surgery, reduce complications and mortality is extremely important.%目的:探讨左半肝切除术后病人的护理,总结护理经验,减少并发症的发生.方法:总结我科2013年1月~2015年1月,32例胰左半肝切除病人手术后的护理情况,从中总结经验.结果:我科32例左半肝切除术病人均未发生并发症,取得了较满意的效果.结论:加强手术前后病情的细致观察和精心护理对提高手术成功率、减少并发症和死亡率极为重要.

  2. The potential impact of a cataract surgery programme on the care of orphans and vulnerable children in Swaziland.

    Science.gov (United States)

    Pons, J; Mapham, W E; Newsome, B; Myer, L; Anderson, R; Courtright, P; Cook, C

    2012-02-23

    We aimed to evaluate the potential impact of a cataract surgery programme at the Good Shepherd Hospital, Siteki, Swaziland, on the care of orphans and vulnerable children in Swaziland. We studied consecutive patients aged 50 years and older undergoing surgery for age-related cataract who reported having children living in their household. Of 131 subjects recruited, 65 (49.6%) were the primary caregivers for the child(ren) in their household. Visual acuities measured 2 weeks after surgery significantly improved. Four weeks after surgery, there was a sizable increase in the proportions of subjects who were able to undertake self-care activities, attend to activities of daily living, undertake income-generating activities and care for children. Cataract surgery on elderly visually impaired patients has the potential to impact positively on the care of orphans and vulnerable children.

  3. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  4. [Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

    Science.gov (United States)

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

    Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR.

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

    OpenAIRE

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

    2016-01-01

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

  6. Physical and rehabilitation medicine (PRM) care pathways: "patients after knee ligament surgery".

    Science.gov (United States)

    Calmels, P; Ribinik, P; Barrois, B; Le Moine, F; Yelnik, A-P

    2011-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after knee ligament surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (WHO).

  7. Physical and rehabilitation medicine (PRM) care pathways: "patients after rotator cuff tear surgery".

    Science.gov (United States)

    Ribinik, P; Calmels, P; Barrois, B; Le Moine, F; Yelnik, A P

    2011-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after rotator cuff tear surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (ICF) (WHO).

  8. DayAND#8211;Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection

    Directory of Open Access Journals (Sweden)

    Selim Sozen

    2012-06-01

    Conclusion: An ideal surgical procedure for a pilonidal sinus should be one aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption, and preventing recurrence. The method described in this paper was found to be simple, safe, and feasible as day-care surgery. The technique of sinotomy with a good wound and surrounding skin care is an ideal approach with a high chance of cure. The patients returned to their routine within a short duration of time. [Arch Clin Exp Surg 2012; 1(3.000: 138-141

  9. DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients?

    Science.gov (United States)

    Montero Ruiz, Eduardo; Barbero Allende, José María; Melgar Molero, Virginia; Rebollar Merino, Ángela; García Sánchez, Marta; López Álvarez, Joaquín

    2015-05-01

    A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons. Copyright © 2012 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam.

    Science.gov (United States)

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. A total of sixty adult patients of age group 18-65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  11. The Evaluation of Nursing Care Satisfaction and Patient Learning Needs in day Case Surgery.

    Science.gov (United States)

    Goktas, Sonay B; Yildiz, Tülin; Nargiz, Sibel Kosucu

    2015-12-01

    Patients in surgical service units have higher expectations for treatment and care. The aims of this study were to determine nursing care satisfaction and information requirements at the time of discharge of patients from a day surgery unit and to assess the effects of demographics. The study was conducted on 291 patients undergoing day case surgery. Patient perception scale for nursing care (PPSN) and the patient learning needs scale (PLNS) were used and total and sub-dimension points averages were calculated and then compared with demographic data using the Kruskal-Wallis test. The results were evaluated at the p patients, 58.8 % (n = 171) were females and the average age was 49.5 ± 15.3 years. PPSN and PLNS total point averages were 68.16 ± 10.17 and 178.53 ± 27.59, respectively. A significant difference was determined in PPSN total point average with regard to previous hospitalisations; the PPSN total point average was higher for patients with prior hospitalisations (p patient satisfaction and patient information requirements could change according to demographic features of the patients at a day case surgery unit. In this respect, healthcare providers should offer healthcare services by evaluating the personal characteristics of patients because this is important for their satisfaction.

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

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    Marco Ranucci

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

  13. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

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    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  14. Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital.

    Science.gov (United States)

    Akhtar, Mohammad Irfan; Sharif, Hasanat; Hamid, Mohammad; Samad, Khalid; Khan, Fazal Hameed

    2016-01-01

    Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.

  15. Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas

    DEFF Research Database (Denmark)

    Homøe, P; Sørensen, H C Florian; Tos, M

    2009-01-01

    OBJECTIVES: We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas...... was assessed using median air conduction pure tone average gain, and the 'take rate' (i.e. the percentage of total ears with a closed perforation) was evaluated. RESULTS: All patients attended for follow up. Eighty-two per cent had at least one perforation closed, and the overall take rate was 65 per cent...... of the 34 ears. The median air conduction pure tone average gain after two years was 18 dB and 13 dB for the right and left ears, respectively. Fourteen patients (82 per cent) obtained an air conduction pure tone average hearing level of ear. In total, 71 per cent of the patients...

  16. General surgery training in Spain: core curriculum and specific areas of training.

    Science.gov (United States)

    Miguelena Bobadilla, José Ma; Morales-García, Dieter; Iturburu Belmonte, Ignacio; Alcázar Montero, José Antonio; Serra Aracil, Xabier; Docobo Durantez, Fernando; López de Cenarruzabeitia, Ignacio; Sanz Sánchez, Mercedes; Hernández Hernández, Juan Ramón

    2015-03-01

    The royal decree RD 639/2014 has been published, regulating among others, the core curriculum, and specific areas of training (SAT). It is of great interest for the specialty of General and Digestive Surgery (GS and DS). The aim is to expose and clarify the main provisions and reflect on their implications for the practical application of the core curriculum and SAT in the specialty of General and Digestive Surgery, to promote initiatives and regulations. This RD will be a milestone in our specialty that will test the strength of the specialty, if it does not finally culminate in its degradation against the emergence of new surgical specialties. A new stage begins in which the Spanish Association of Surgeons should be involved to define the conceptual basis of GS and DS in the XXI century, and the creation of new SAT to continue to maintain the "essence of our specialty".

  17. Evaluation of Bluetooth as a replacement for cables in intensive care and surgery.

    Science.gov (United States)

    Wallin, Mats K E B; Wajntraub, Samson

    2004-03-01

    In today's intensive care and surgery, a great number of cables are attached to patients. These cables can make the care and nursing of the patient difficult. Replacing them with wireless communications technology would facilitate patient care. Bluetooth is a modern radio technology developed specifically to replace cables between different pieces of communications equipment. In this study we sought to determine whether Bluetooth is a suitable replacement for cables in intensive care and during surgery with respect to electromagnetic compatibility. The following questions were addressed: Does Bluetooth interfere with medical equipment? And does the medical equipment decrease the quality of the Bluetooth communication? A Bluetooth link, simulating a patient monitoring system, was constructed with two laptops. The prototype was then used in laboratory and clinical tests according to American standards at the Karolinska Hospital in Stockholm. The tests, which included 44 different pieces of medical equipment, indicated that Bluetooth does not cause any interference. The tests also showed that the hospital environment does not affect the Bluetooth communication negatively. Bluetooth, a new radio technology transmitting at 2.4 GHz, was tested in a clinical setting. The study showed that a single Bluetooth link was robust and electromagnetically compatible with the tested electronic medical devices.

  18. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care.

    Science.gov (United States)

    Vaughn, Lisa M; DeJonckheere, Melissa; Pratap, Jayant Nick

    2016-06-09

    Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.

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

    Science.gov (United States)

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

    2016-03-01

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

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

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    , randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE...... (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational...

  1. POST ANAESTHETIC RECOVERY FOLLOWING DAY-CARE SURGERY: COMPARISON OF TWO ANAESTHETIC TECHNIQUES

    Directory of Open Access Journals (Sweden)

    Dhrubajyoti

    2016-04-01

    Full Text Available BACKGROUND The growing demand for early discharge from hospital, consequent early return to work has resulted in the evolution of concept of “day care surgery.” This has led to development of precise safe anaesthetic techniques and agents as well as a battery of tests of recovery. Day care surgery presents unique challenges for the anaesthetists to produce a ‘street fit’ patient as soon as possible after the surgery with least complications, which can be achieved by both intravenous and inhalational techniques. Thus, an endeavour was made to carry out the present study with the aims and objectives to assess the progress of recovery in patients undergoing day care surgery with two groups of intravenous anaesthetic agents and also to determine the optimum time taken to achieve “home readiness.” METHODS The study included patients of average intelligence of both sexes aged between 15 and 45 yrs. belonging to physical status ASA I and II, undergoing operative procedures less than 30 minutes in our institute over a period of two years. A randomized double blind study was done amongst 80 patients scheduled for day care surgery, where two techniques were compared. Amongst 2 groups [Group I: Propofol (1% and Group II: Thiopentone (2.5% as the intravenous anaesthetic agent]. Recovery was assessed using standard scoring systems. The different variables were evaluated by mean and standard deviation. For comparing two groups, paired ‘t’ test was applied and a p value of ˂0.05 was considered significant. RESULTS The mean total dose requirement in Group-II patients were more than that in Group-I patients (p0.05, but the quality of anaesthesia was excellent in 57.5% in Group-I as compared to 45% in Group-II. After 5 minutes of cessation of anaesthesia, patients in Group-I attained much higher score as compared to Group-II (p<0.001 as assessed by the “Steward scoring system.” More number of patients were “Home ready” in Group-I than in

  2. The Burden of Care for Children With Unilateral Cleft Lip: A Systematic Review of Revision Surgery.

    Science.gov (United States)

    Sitzman, Thomas J; Coyne, Sarah M; Britto, Maria T

    2016-07-01

    To identify the average rate of revision surgery following cleft lip repair. PubMed, CINAHL, and SCOPUS were searched from database inception through March 2013 using the search terms cleft lip and surgery. Two investigators independently screened all abstracts and determined eligibility from review of full manuscripts using prespecified inclusion and exclusion criteria. Strengths and limitation of the studies were assessed, followed by qualitative synthesis. The I(2) test of homogeneity was performed to determine if meta-analysis was appropriate. The search identified 3034 articles. Of those, 45 met the inclusion criteria. Studies were primarily case series and retrospective cohort studies, with only one randomized controlled trial. One-third of studies (n = 15) did not describe how the study sample was selected. Follow-up duration was not reported in one-fourth of studies (n = 11). Nasolabial aesthetics were reported in 44% of studies (n = 20). The incidence of revision surgery ranged from 0% to 100%. Meta-analysis was precluded because of study heterogeneity (I(2) = 97%). The average incidence of cleft lip revision surgery cannot be estimated from the published literature, due to significant heterogeneity among existing reports and limited study quality. To provide valid information about the burden of care for unilateral cleft lip, a population-based or multicenter longitudinal cohort study is necessary; this study should measure the number of surgical procedures and the patient's aesthetic outcomes.

  3. Information available on the internet about pain after orthognathic surgery: A careful review

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    Matheus Melo Pithon

    2014-12-01

    Full Text Available OBJECTIVE: Investigate the quality of data available on the internet with respect to pain after orthognathic surgery.METHODS: A careful search was conducted on the Internet in December, 2012. The most accessed websites browsers were employed for research using the terms: "pain" and "orthognathic surgery" together. The first 30 results of each portal were examined, and after applying the exclusion criteria, 29 sites remained. All remaining websites went through an evaluation process with online tools that investigated the quality, level of reading, accessibility, usability and reliability.RESULTS: Assessment criteria outcomes were considered unfavorable. Texts were considered difficult to read with inappropriate language for the general public. The mean global validation for the 29 websites of the LIDA instrument was 65.10, thereby indicating a structure of medium quality.CONCLUSION: Information about post-orthognathic surgery pain available on the internet is poorly written and unreliable. Therefore, candidates for orthognathic surgery must seek information from specialists who, in turn, should indicate reliable sources.

  4. Conservative Care in Lumbar Spine Surgery Trials: A Descriptive Literature Review.

    Science.gov (United States)

    Yang, Aaron J; Coronado, Rogelio A; Hoffecker, Lilian; Gao, Chan; Saurwein, Kelly; Shoreman, Danielle; Hoffberg, Adam S; Akuthota, Venu

    2017-01-01

    To evaluate the degree to which conservative care and failure were specifically defined in studies comparing nonoperative treatment versus surgery for low back pain (LBP) conditions in adults. A comprehensive literature search was conducted by an experienced librarian using MEDLINE (PubMed), Embase, Google Scholar, and CENTRAL from January 2003 to June 2014. Endnote bibliographic management application was used to remove duplicates and organize the citations. Prospective, randomized, or cohort trials comparing surgery versus conservative intervention for patients with LBP conditions. Study selection was conducted by 2 independent reviewers. Three independent reviewers extracted data from each article using a structured data extraction form. Data extracted included type of study, participant characteristics, sample size, description, and duration of conservative care and whether failed conservative care criterion was defined. A total of 852 unique records were screened for eligibility; of those, 72 articles were identified for further full-text review. Thirty-four full texts were excluded based on the exclusion criteria, and 38 articles, representing 20 unique studies, were included for qualitative synthesis. Fifteen of the 20 studies defined the duration of conservative care. Only 3 studies defined the dosage of physical therapy sessions, including total number of visits and visit duration. Two studies described medication usage, including the duration and type. No studies specifically defined what constituted failed conservative therapy. This literature review suggests conservative care is poorly defined in randomized trials, which can lead to ambiguity of research procedures and unclear guidelines for clinicians. Future studies should increase transparency and explicitly define conservative care. Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.

  5. Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.

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    Jasper van der Slegt

    Full Text Available BACKGROUND: Surgical site infections (SSI's are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP was introduced in 2009. The elements of the bundle were (1 perioperative normothermia, (2 hair removal before surgery, (3 the use of perioperative antibiotic prophylaxis and (4 discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4% SSI were observed. Deep SSI occurred in 25 (3.5% patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001 and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001 had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63. Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing

  6. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system.

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Goepfert, M; Gogarten, W; Grosse, J; Heller, A R; Heringlake, M; Kastrup, M; Kroener, A; Loer, S A; Marggraf, G; Markewitz, A; Reuter, D; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2010-06-15

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical

  7. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

    Directory of Open Access Journals (Sweden)

    Schmitt, D. V.

    2010-01-01

    Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the

  8. Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.

    Science.gov (United States)

    Leroux, Eric J; Morton, John M; Rivas, Homero

    2014-08-01

    To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

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

    Science.gov (United States)

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

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

  10. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB).

    Science.gov (United States)

    Rosato, L; De Crea, C; Bellantone, R; Brandi, M L; De Toma, G; Filetti, S; Miccoli, P; Pacini, F; Pelizzo, M R; Pontecorvi, A; Avenia, N; De Pasquale, L; Chiofalo, M G; Gurrado, A; Innaro, N; La Valle, G; Lombardi, C P; Marini, P L; Mondini, G; Mullineris, B; Pezzullo, L; Raffaelli, M; Testini, M; De Palma, M

    2016-08-01

    The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.

  11. Psychosocial stress at work and perceived quality of care among clinicians in surgery.

    Science.gov (United States)

    Klein, Jens; Grosse Frie, Kirstin; Blum, Karl; von dem Knesebeck, Olaf

    2011-05-20

    Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI) and the demand-control model (job strain). The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57) and 3.21 (CI 2.23-4.61). Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.

  12. Psychosocial stress at work and perceived quality of care among clinicians in surgery

    Directory of Open Access Journals (Sweden)

    von dem Knesebeck Olaf

    2011-05-01

    Full Text Available Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI and the demand-control model (job strain. The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Results Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57 and 3.21 (CI 2.23-4.61. Conclusion Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.

  13. Surgery Goes Social: The Extent and Patterns of Social Media Utilization by Major Trauma, Acute and Critical Care Surgery Societies.

    Science.gov (United States)

    Khalifeh, Jawad M; Kaafarani, Haytham M A

    2017-01-01

    The evolving influence of social media in trauma, acute, and critical care surgery (TACCS) cannot be ignored. We sought to investigate the extent and patterns of use of social networks by major regional, national and international TACCS societies. The two leading social networking sites, Facebook (FB) and Twitter (TW), were thoroughly examined for the presence of official accounts for each of the major TACCS societies. An official FB or TW account was defined as one which has a blue verified badge and/or is linked the society's official website. For societies with confirmed official accounts, the extent and patterns of use of the two platforms were systematically examined over a 2-week period through: (1) manual inspection of the societies' FB and TW pages, (2) the SQLite database containing downloaded samples of posts, and (3) the TW analytics database, symplur.com. Standardized social media metrics were calculated for each society. Posted content was categorized as being: (1) society news updates, (2) event announcements, or (3) general medical information. From a total of 64 TACCS societies, only 27 (42%) had FB and/or TW accounts. Ten out of the 12 American societies had accounts compared to 13/39 of European, 2/9 of Australasian, and 0/2 of international societies. For the societies with social media presence, the mean numbers of monthly tweets and FB posts per society were 22 and 8, respectively. We summarize the FB and TW activity of the studied TACCS societies. Most tweets/posts were society news updates and event announcements intended to the society's constituents not the general public. A text cloud was constructed to summarize the major featured topics. Less than half of the TACCS societies are currently using social media; those that do are arguably underutilizing its potential. Non-American societies in particular lag behind in their use of social networking.

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

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    Julia de las Pozas Abril

    2011-07-01

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

  15. The influence of country of origin on engagement in self-care behaviours following heart surgery: a descriptive correlational study.

    Science.gov (United States)

    Fredericks, Suzanne

    2012-08-01

    The aim of this study was to determine whether an individual's country of origin influenced performance of self-care behaviours after heart surgery. Patients are required to perform self-care behaviours following cardiovascular surgery. Usual care encompasses a patient education initiative that addresses self-care behaviour performance. Within Canada, current heart surgery patient education efforts have been designed and evaluated using homogenous samples that self-identify their country of origin as England, Ireland or Scotland. However, approximately 42·6% of Canadian cardiovascular surgical patients self-identify their country of origin as India or China. Thus, current cardiovascular surgery patient education initiatives may not be applicable to all patients undergoing heart surgery, which may result in decreased patient outcomes such as performance of self-care behaviours. This descriptive study. A convenience sample of 90 patients who underwent heart surgery at one of two university-affiliated teaching hospitals, representing individuals of diverse backgrounds. Point-biserial correlational analysis was conducted to determine the relationship between country of origin and performance of self-care behaviours. Findings indicate individuals who self-identified their country of origin as England or Ireland were associated with a higher score on the number of self-care behaviours performed (p study provides preliminary evidence to suggest country of origin influences the amount of self-care behaviours individuals will perform. Patient education initiatives should incorporate the values, beliefs, attitudes and customs reflective of an individual's country of origin to enhance the likelihood of producing desired outcomes. © 2012 Blackwell Publishing Ltd.

  16. Choosing a hospital for surgery: the importance of information on quality of care.

    Science.gov (United States)

    Dijs-Elsinga, Joyce; Otten, Wilma; Versluijs, Martine M; Smeets, Harm J; Kievit, Job; Vree, Robbert; van der Made, Wendeline J; Marang-van de Mheen, Perla J

    2010-01-01

    To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical procedures in 2005-2006 (aorta reconstruction [for treatment of aneurysm], cholecystectomy, colon resection, inguinal hernia repair, esophageal resection, thyroid surgery). Patients were asked which information they had used to choose this hospital and which information they intended to use if they would need similar surgical treatment in the future. In total, 1329 questionnaires were available for analysis (response rate 62.6%). Most patients indicated having used the hospital's good reputation (69.1%) and friendly hospital atmosphere (63.3%) to choose a hospital. For future choices, most patients intended to use the fact that they were already treated in that hospital (79.3%) and the hospital's good reputation (74.1%). Regarding quality-of-care information, patients preferred a summary measure (% patients with ''textbook outcome'') over separate more detailed measures (52.1% v. 38.0%, χ2 = 291, P value that they were already treated in that hospital or a hospital's good reputation even more.

  17. Effects of implementation of an urgent surgical care service on subspecialty general surgery training

    Science.gov (United States)

    Wood, Leanne; Buczkowski, Andrzej; Panton, Ormond M.N.; Sidhu, Ravi S.; Hameed, S. Morad

    2010-01-01

    Background In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents’ attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents’ time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.028), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion Residents’ education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. PMID:20334744

  18. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

    Science.gov (United States)

    Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre

    2017-06-01

    Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All

  19. Teamwork in skull base surgery: An avenue for improvement in patient care.

    Science.gov (United States)

    McLaughlin, Nancy; Carrau, Ricardo L; Kelly, Daniel F; Prevedello, Daniel M; Kassam, Amin B

    2013-01-01

    During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: "teamwork", "multidisciplinary", "interdisciplinary", "surgery", "skull base", "neurosurgery", "tumor", and "outcome". Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support. Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise.

  20. Intraoperative Motor Symptoms during Brain Tumor Resection in the Supplementary Motor Area (SMA) without Positive Mapping during Awake Surgery.

    Science.gov (United States)

    Nakajima, Riho; Nakada, Mitsutoshi; Miyashita, Katsuyoshi; Kinoshita, Masashi; Okita, Hirokazu; Yahata, Tetsutaro; Hayashi, Yutaka

    2015-01-01

    Awake surgery could be a useful modality for lesions locating in close proximity to the eloquent areas including primary motor cortex and pyramidal tract. In case with supplementary motor area (SMA) lesion, we often encounter with intraoperative motor symptoms during awake surgery even in area without positive mapping. Although the usual recovery of the SMA syndrome has been well documented, rare cases with permanent deficits could be encountered in the clinical setting. It has been difficult to evaluate during surgery whether the intraoperative motor symptoms lead to postoperative permanent deficits. The purpose of this study was to demonstrate the intraoperative motor symptoms could be reversible, further to provide useful information for making decision to continue surgical procedure of tumor resection. Eight consecutive patients (from July 2012 to June 2014, six men and two women, aged 33-63 years) with neoplastic lesions around the SMA underwent an awake surgery. Using a retrospective analysis of intraoperative video records, intraoperative motor symptoms during tumor resection were investigated. In continuous functional monitoring during resection of SMA tumor under awake conditions, the following motor symptoms were observed during resection of the region without positive mapping: delayed motor weakness, delay of movement initiation, slowness of movement, difficulty in dual task response, and coordination disturbance. In seven patients hemiparesis observed immediately after surgery recovered to preoperative level within 6 weeks. During awake surgery for SMA tumors, the above-mentioned motor symptoms could occur in area without positive mapping and might be predictors for reversible SMA syndrome.

  1. ESBLs producing Enterobacteriaceae in critical care areas – a clinical and cost analysis from a tertiary health care centre

    Directory of Open Access Journals (Sweden)

    Hena Rani

    2012-04-01

    Full Text Available Objective: ESBLs pose a major threat in clinical therapeutics. In the present study we have tried to do clinical analysis of one hundred ESBLs producing Enterobacteriaceae isolates from various clinical specimens from patients admitted in critical care areas. Methods: ESBLs detection was done by CLSI, DDS and Vitek methods. Clinical analysis of each patient was done by regularly visiting in CCA and reviewing patient’s status and medical records. Results: All of the 13 patients on foley’s catheter grew ESBLs positive isolates and amongst 10 non catheterized patients, 9 grew ESBLs negative isolates. Thirteen out of 14 patients on CVP/arterial line grew ESBLs positive isolates. Out of 24 patients who underwent surgery, 22 grew ESBLs positive isolate. Forty seven out of 68 patients who were on 3rd or 4th generation cephalosporins within last 1 month of giving the sample grew ESBLs positive isolates. Conclusion: We have found a statistically significant (p<0.0.05 relationship in between foley’s catheterization and production of ESBLs from urinary isolates. There was no statistically significant association in between CVP/arterial line and blood culture isolates. We did not find difference in mortality rates in between patients infected with ESBLs positive or negative isolates. The mortality in patients was associated with their primary illness or associated co-morbid conditions. We found that the detection of ESBLs is important for the de-escalation of therapy thereby saving net cost of treatment.

  2. Referral patterns and the referral system for oral surgery care. Part 2: The referral system and telemedicine.

    Science.gov (United States)

    Coulthard, P; Kazakou, I; Koran, R; Worthington, H V

    2000-04-08

    To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals. Postal questionnaire. 400 GDPs in Greater Manchester. 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners. There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care.

  3. COMPARISON OF DEXMEDETOMIDINE WITH FENTANYL FOR SEDATION IN TYMPANOPLASTY (ENT SURGERIES DONE UNDER MONITORED ANAESTHESIA CARE

    Directory of Open Access Journals (Sweden)

    Illendula

    2016-02-01

    Full Text Available INTRODUCTION Monitored anaesthesia care involves administering a combination of drugs for anxiolytic, hypnotic, amnestic and analgesic effect. Ideally it should result in less physiological disturbance and allow for more rapid recovery than general anaesthesia. It typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and analgesic drugs which is a common practice during various ENT surgical procedures. AIM OF STUDY Is to “Compare Dexmedetomidine with Fentanyl for sedation in tympanoplasty (ENT Surgeries”. The objective of the study is to evaluate the efficacy of dexmedetomidine and fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in Tympanoplasty (ENT surgeries METHODS & MATERIALS A total of 60 patients are being recruited into this study with regards to assess, Pain, Discomfort, Sedation, Peripheral Oxygen Saturation (SPO2 & Systolic Blood Pressure (SBP, Diastolic blood pressure (DBP, Mean arterial blood pressure(MAP & Heart rate This study was undertaken at Govt. ENT Hospital Hyderabad. Sixty (60 patients undergoing Tympanoplasty surgery were taken for study. Thus the study contains 30 patients in Dexmedetomidine group-(Group D and 30 patients in Fentanyl group (Group F RESULT Dexmedetomidine provides less discomfort, better sedation, and analgesia when compared with fentanyl under monitored anaesthesia care (Conscious sedation. However, the risk of adverse effects requires monitoring for ready intervention. It provides a unique type of sedation, “conscious sedation” in which patients appear to be sleepy but are easily arousable, cooperative and communicative when stimulated. It is sedative and analgesic agent, with opioid-sparing properties and minimal respiratory depression.

  4. Parental perceptions of transition from intensive care following a child's cardiac surgery.

    Science.gov (United States)

    Obas, Katrina A; Leal, Jessica M; Zegray, Michele; Rennick, Janet E

    2016-05-01

    Children with congenital heart disease (CHD) who undergo cardiac surgery are hospitalized in a paediatric intensive care unit (PICU) prior to being transferred to a surgical ward. This is a challenging transition for parents of children with CHD who experience high levels of stress related to their child's illness. To explore parents' perceptions of the transition from the PICU to the surgical ward following their child's cardiac surgery. A qualitative descriptive design using semi-structured interviews was used to explore parents' perceptions of the transfer experience. All parents of children with CHD who met inclusion criteria were approached to participate. Parents were recruited until data saturation was achieved (n = 9). Interviews were audiotaped and transcribed verbatim. Transcripts were coded and thematically analysed concurrently with data collection. Parents described having mixed feelings of happiness and uncertainty upon learning that their child would be transferred to the surgical ward (theme 1). Parents' uncertainty prompted a need to rally for the upcoming transfer, a process in which the nurse was perceived to play an important role (theme 2). Once transferred to the surgical ward, parents described having to come to terms with a new care experience in which they encountered new role expectations and a challenging new environment (theme 3). Emotional reactions to transfer were generally consistent with the literature, although parents in our study did not describe feelings of isolation related to transition as reported elsewhere. We also identified the timing of transfer as a potential source of stress for parents. Parents identified key nursing interventions that helped them to prepare for transfer and come to terms with challenges in their new environment. A deeper understanding of parents' transfer experience will facilitate the development of effective nursing interventions to support parents at this time. © 2015 British Association of

  5. Risk stratification in motor area-related glioma surgery based on navigated transcranial magnetic stimulation data.

    Science.gov (United States)

    Rosenstock, Tizian; Grittner, Ulrike; Acker, Güliz; Schwarzer, Vera; Kulchytska, Nataliia; Vajkoczy, Peter; Picht, Thomas

    2016-06-03

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is a noninvasive method for preoperatively localizing functional areas in patients with tumors in presumed motor eloquent areas. The aim of this study was to establish an nTMS-based risk stratification model by examining whether the results of nTMS mapping and its neurophysiological data predict postoperative motor outcome in glioma surgery. METHODS Included in this study were prospectively collected data for 113 patients undergoing bihemispheric nTMS examination prior to surgery for gliomas in presumed motor eloquent locations. Multiple ordinal logistic regression analysis was performed to test for any association between preoperative nTMS-related variables and postoperative motor outcome. RESULTS A new motor deficit or deterioration due to a preexisting deficit was observed in 20% of cases after 7 days and in 22% after 3 months. In terms of tumor location, no new permanent deficit was observed when the distance between tumor and corticospinal tract was greater than 8 mm and the precentral gyrus was not infiltrated (p = 0.014). New postoperative deficits on Day 7 were associated with a pathological excitability of the motor cortices (interhemispheric resting motor threshold [RMT] ratio 110%, p = 0.031). Interestingly, motor function never improved when the RMT was significantly higher in the tumorous hemisphere than in the healthy hemisphere (RMT ratio > 110%). CONCLUSIONS The proposed risk stratification model, based on objective functional-anatomical and neurophysiological measures, enables one to counsel patients about the risk of functional deterioration or the potential for recovery.

  6. Orthognathic Surgery Patients (Maxillary Impaction and Setback plus Mandibular Advancement plus Genioplasty) Need More Intensive Care Unit (ICU) Admission after Surgery

    Science.gov (United States)

    Eftekharian, Hamidreza; Zamiri, Barbad; Ahzan, Shamseddin; Talebi, Mohamad; Zarei, Kamal

    2015-01-01

    Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013) were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL), postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed. Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1%) were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%). There was not statistically significant difference in age and sex between the two groups (p> 0.05). The groups were significantly different in terms of operation time (p< 0.001). Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001). Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001). Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%), while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001). Conclusion: Orthognathic surgery patients (maxillary

  7. Orthognathic Surgery Patients (Maxillary Impaction and Setback Plus Mandibular Advancement Plus Genioplasty Need More Intensive Care Unit (ICU Admission after Surgery

    Directory of Open Access Journals (Sweden)

    Hamidreza Eftekharian

    2015-03-01

    Full Text Available Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013 were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL, postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed. Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1% were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%. There was not statistically significant difference in age and sex between the two groups (p> 0.05. The groups were significantly different in terms of operation time (p< 0.001. Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001. Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001. Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%, while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001. Conclusion: Orthognathic surgery patients

  8. [Palliative care needs in the inmobilized population of a Primary Care area in Vigo Spain].

    Science.gov (United States)

    Ferraz-Falcao, J R; Cadaval-Rodríguez, T; Rodríguez-Iglesia, R M; del Campo-Pérez, V M

    2015-09-01

    To determine palliative care needs in a sample of people with mobility problems in the area of the C.S. Matama by using the NECPAL instrument (identification and integral-integrated care of people with advanced chronic diseases in social and healthcare provision services). Descriptive and cross-sectional study of patients immobilized in a health centre in Vigo (87 subjects overall). The average age of our patients is 84.34 years and 82% are women. The most frequent immobilization type was the patient's inability to leave their home (64%). The result of this test was positive in 38% of cases (33 patients), most of whom have chronic diseases and only 1 patient has been diagnosed with cancer. There is a significant negative association between the score obtained on the Barthel scale and the ratio of positives to the test. Concerning the use of resources there are important differences regarding hospital admissions and PHC depending on the outcome of the test. These differences were statistically significant with regard to PHC and emergency consultations. An immobilized patient is not synonymous with a patient in need of palliative care; the tool used has been proved to be useful to detect this need, which concerns a third of our patients. The results of the questionnaire of need for care palliative (NECPAL) relate well to the basic activities of daily living (Barthel scale score) and to indicators of use of health services. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Estimating Demand for and Supply of Pediatric Preventive Dental Care for Children and Identifying Dental Care Shortage Areas, Georgia, 2015.

    Science.gov (United States)

    Cao, Shanshan; Gentili, Monica; Griffin, Paul M; Griffin, Susan O; Harati, Pravara; Johnson, Ben; Serban, Nicoleta; Tomar, Scott

    Demand for dental care is expected to outpace supply through 2025. The objectives of this study were to determine the extent of pediatric dental care shortages in Georgia and to develop a general method for estimation that can be applied to other states. We estimated supply and demand for pediatric preventive dental care for the 159 counties in Georgia in 2015. We compared pediatric preventive dental care shortage areas (where demand exceeded twice the supply) designated by our methods with dental health professional shortage areas designated by the Health Resources & Services Administration. We estimated caries risk from a multivariate analysis of National Health and Nutrition Examination Survey data and national census data. We estimated county-level demand based on the time needed to perform preventive dental care services and the proportion of time that dentists spend on pediatric preventive dental care services from the Medical Expenditure Panel Survey. Pediatric preventive dental care supply exceeded demand in Georgia in 75 counties: the average annual county-level pediatric preventive dental care demand was 16 866 hours, and the supply was 32 969 hours. We identified 41 counties as pediatric dental care shortage areas, 14 of which had not been designated by the Health Resources & Services Administration. Age- and service-specific information on dental care shortage areas could result in more efficient provider staffing and geographic targeting.

  10. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

    National Research Council Canada - National Science Library

    Ribeiro, Eleonora R O; Guimarães, Alzira Maria D N; Bettiol, Heloísa; Lima, Danilo D F; Almeida, Maria Luiza D; de Souza, Luiz; Silva, Antônio Augusto M; Gurgel, Ricardo Q

    2009-01-01

    .... The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil...

  11. Pediatric health care provider perceptions of weight loss surgery in adolescents.

    Science.gov (United States)

    Vanguri, Poornima; Lanning, David; Wickham, Edmond P; Anbazhagan, Aruna; Bean, Melanie K

    2014-01-01

    This study explored pediatric health care providers' obesity treatment practices and perceptions about adolescent weight loss surgery (WLS). Surveys were e-mailed to pediatric listservs. After descriptive analyses, correlations, chi-squares, and one-way analyses of variance compared responses by provider characteristics. Surveys were completed by 109 providers. Almost half do not routinely measure body mass index. Providers typically counsel patients about lifestyle change, with limited perceived benefit; pediatrics" (17%) as reasons. However, when presented with patient scenarios of different ages and comorbidities, likeliness to refer for WLS increased substantially. Surgeons, younger providers and those with fewer years of experience were more likely to refer for WLS (P pediatric provider resistance to refer obese adolescents remains. Improved referral and management practices are needed.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  13. Intraoperative direct electrical stimulations of central nervous system during surgery of gliomas near eloquent areas

    Directory of Open Access Journals (Sweden)

    WANG Wei-min

    2012-12-01

    Full Text Available Objective To report our experiences of direct cortical stimulation in surgery of gliomas located in eloquent areas. Methods Clinical data of 157 patients with gliomas underwent awake craniotomy with the direct electrical stimulation for functional mapping of the eloquent areas were analysed retrospectively. Results Negative cortical stimulation was found in 4 patients, and positive cortical stimulation was achieved in 153 patients (97.45% . Four hundred and ninty -six cortical sites in 139 patients were detected for motor response by direct electrical stimulation, 70 sites in 21 patients for sensory, 112 sites in 91 patients for language (such as counting and naming. The positive areas of counting disturbance were mainly seen at the lower part of left precentral gyri operculum of left inferior frontal gyri, triangular part of left inferior frontal gyri, posterior part of left middle frontal gyri, and posterior part of left superior frontal gyri. Postoperative MRI showed 92 patients (58.60% achieved total resection, 55 cases (35.03% subtotal and 10 cases (6.37% partial. One hundred and ten patients (70.06% were diagnosed as having low grade glimas, including 71 cases of astrocytoma, 26 cases of oligodendroglioma, and 13 cases of mixed astro ? oligodendroglioma, 47 patients (29.94% were high grade gliomas, including 19 cases of glioblastoma, 15 cases of anaplastic astrocytoma, and 13 cases of anaplastic oligodendroglioma. After operation 53 patients (33.76% occurred transient postoperative paralysis, 39 patients (24.84% transient language disturbance and 4 patients (2.55% permanent neurological deficits. Conclusion Intraoperative direct electrical stimulation is a reliable, precise and safety method for functional mapping of the eloquent areas. This technique allows us to achieve 'maximal safety resection' in glioma surgery.

  14. Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

    Directory of Open Access Journals (Sweden)

    Horacio N. López-Basave

    2014-01-01

    Full Text Available Introduction. Cytoreductive surgery (CS with hyperthermic intraperitoneal chemotherapy (HIPEC is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m2/L and mitomycin C 3.3 mg/m2/L for 90-minutes at 40.5°C. Results. 26 (67% of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%. The mean time on surgical procedures was 7.06 hours (range 5−9 hours. The mean blood loss was 939 ml (range 100–3700 ml. The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.

  15. Pro patria et spes gentis: military medicine, paediatric surgery and those who care for children.

    Science.gov (United States)

    Pearn, John

    2011-12-01

    Children and military medicine have many links. On humanitarian and disaster deployments, the surgery of war has increasingly seen children as the focus of clinical salvage. When Romans spoke of children, they used the phrase 'spes gentis'-'the hope of the race'. In modern times, there developed a synergy, in the context of defensive war, that its prosecution depended not only on the defence of territory but also on its hopes for continuation of people and culture, into the future. In the 19th century, in Australia, several regiments had the motto 'Pro Aris et Focis'-'For the Defence of Hearth and Home'. Hearth implies the family and that implies children. From the point of view of an attending military clinician, the centrum of all medical care is the patient himself, and that centrality is reflected equally in the helplessness of a bomb-blast or gunshot victim as it is in the vulnerability of a sick or injured infant or child. The life and service of Major General Rupert Downes (1885-1945), whom the Downes Memorial Lecture commemorates, reflected this nexus. His career was that of a national leader in military medicine and that of paediatric surgery. The 2011 Rupert Downes Lecture explores and documents the extraordinary corpus of service of Australian paediatric surgeons and their contributions to military medicine from the 19th to the 21st centuries.

  16. Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

    Directory of Open Access Journals (Sweden)

    Campbell JP

    2016-08-01

    Full Text Available James P Campbell, Byron P Vaughn Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA Abstract: Despite improvements in medical therapies for Crohn’s disease (CD, up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence. Keywords: Crohn’s disease, postoperative care, postoperative recurrence

  17. Rapid response team implementation on a burn surgery/acute care ward.

    Science.gov (United States)

    Moroseos, Teresa; Bidwell, Karen; Rui, Lin; Fuhrman, Lawrence; Gibran, Nicole S; Honari, Shari; Pham, Tam N

    2014-01-01

    To date there is limited evidence of efficacy for rapid response teams (RRT) in burns despite widespread their implementation in U.S. hospitals. The burn surgery/acute care ward at the Harborview Medical Center, Seattle, Washington, primarily treats burns, acute wounds, and pediatric trauma patients, but also accepts overflow surgical and medical patients. The authors hypothesize that institutional RRT implementation in 2006 has reduced code blue activations, unplanned intensive care unit (ICU) transfers, and mortality on the acute care ward of this hospital. The authors retrospectively analyzed all patients treated in our acute care unit before (2000-2004) and after RRT implementation (2007-2011). Patient, injury, and treatment outcomes information were collected and analyzed. The authors specifically examined clinical signs that triggered RRT activation and processes of care after activation. They compared code blue activation rates, unplanned ICU transfers, and mortality between the two periods by Poisson regression. The acute care unit treated 7092 patients before and 9357 patients after RRT implementation. There were 409 RRT activations in 329 patients, 18 of whom ultimately died during hospitalization. Those who died had higher rates of stridor (P = .03), tachypnea (P = .001), and low oxygen saturations (P = .02) compared with survivors. Fewer burn and surgical patients died after implementation (seven patients; 22% of all deaths) compared with patients who died pre-RRT (27 patients; 53% of all deaths). After adjustment for case-mix index, age, and medical service differences between the two periods, code blue calls decreased from 1.4/1000 to 0.4/1000 admissions (P = .04), unplanned ICU transfer rates decreased from 65/1000 to 50/1000 admissions (P < .01), and hospital deaths decreased from 4.5/1000 to 3.3/1000 admissions (P = .11). Since its implementation, RRT activation has been frequently used in the acute care ward of this hospital. Respiratory symptoms

  18. Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial.

    Science.gov (United States)

    Khant, Shahil Rameshbhai; Chaudhari, Rajeev; Kore, Rishikesh Arun; Bhagwat, Shirish; Jakhalekar, Ranjan Purushottam

    2017-06-01

    urological procedures. It also favours day care surgery at remote areas with lesser medical facilities. It helps to minimize requirement of medical and paramedical staff, thus further extending scope of day care urological surgeries.

  19. The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients.

    Science.gov (United States)

    Dunlap, Jonathan L; Jaramillo, Joshua D; Koppolu, Raji; Wright, Robert; Mendoza, Fernando; Bruzoni, Matias

    2015-09-01

    Hispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient-provider language concordance on a pediatric surgery practice. A surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider-patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences. We administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (ppediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient satisfaction and understanding of surgical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. ORGANIZATION AND PROCEDURES GUIDE FOR PERFORMING MAJOR AMBULATORY AND SHORT-STAY SURGERY IN COORDINATION WITH THE PRIMARY HEALTH CARE TEAM

    Directory of Open Access Journals (Sweden)

    Javier Cruz Rodríguez

    2015-11-01

    Full Text Available Currently, there are constraints on coordination between the primary and secondary levels of care, and we lack a regulatory document for surgical activity in major ambulatory and short-stay surgery, which affects the quality of this modality of care. Such reasons led to the design of the “Organization and Procedures Guide for Performing Major Ambulatory and Short-stay Surgery in Coordination with the Primary Health Care Team". The guide was assessed by 90 experts with experience in the primary and secondary levels of care, who endorsed the quality and relevance of the proposal. It contains recommendations to help primary and secondary care professionals involved in surgical care to select the most appropriate approach to conditions treated by means of ambulatory or short-stay surgery. The recommendations are based on the latest available scientific evidence supporting the use of ambulatory surgery, short-stay surgery and home hospitalization.

  1. Tumor surgery within cerebral eloquent areas: A two-institutions experience

    Directory of Open Access Journals (Sweden)

    Signorelli Francesco

    2014-07-01

    Full Text Available Introduction: Tumor surgery within eloquent areas represents a formidable challenge and the use of electrical cortico-subcortical stimulation mapping (ESM, allows to localize sensorimotor and language areas and pathways. Our aim is to point out methodological issues of ESM and its impact on outcome at the light of a prospective analysis of a two-institution series of 159 patients with lesions involving eloquent areas with a lengthy follow up. Material and Methods: All patients operated on for lesions involving eloquent areas between May 2000 and May 2010 at the Neurosurgical Department of the Neurological and Neurosurgical Hospital 'P. Wertheimer' in Lyon (France and at the Neurosurgical Department of the University Hospital in Catanzaro (Italy, were enrolled prospectively in our study. Results: Of 159 consecutive patients, 141 of them underwent surgical removal of the lesion with the aid of electrical cortico-subcortical stimulation mapping integrated in a setting of intraoperative localization of anatomic landmarks for eloquent areas. For the remaining 18 patients ESM was not deemed useful or feasible: 15 patients received a biopsy and 3 patients received tumor debulking under general anesthesia. For patients operated with ESM, it was possible to achieve a gross total removal of the lesion in 67,4% of cases (95 patients. One patient died in the immediate postoperative period for a pulmonary embolism. At a total mean follow-up of 62.8 months 78 patients were alive, 62 of which were recurrence free and had a KPS of 70% or more, while the other 80 patients had a mean survival time of 23.9 months, with a mean high quality survival period (KPS ≥ 70 of21.6 months. Discussion and Conclusion: Intraoperative electrical language and motor mapping, when feasible and indicated, consistently localizes eloquent cortical areas and subcortical pathways and allows to set the tumor resection boundaries according to functional limits, with a favorable impact

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

    Directory of Open Access Journals (Sweden)

    Valeria Calcaterra

    2014-09-01

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

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

    Science.gov (United States)

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

    2014-08-12

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

  4. [Guideline 'Wound Care': recommendations for 5 challenging areas].

    Science.gov (United States)

    Brölmann, Fleur E; Vermeulen, Hester; Go, Peter M N Y H; Ubbink, Dirk T

    2013-01-01

    The interdisciplinary evidence-based guideline 'Wound Care' covers the treatment and management of acute wounds in adults and children and by all wound care disciplines. This guideline answers 5 basic questions with 38 recommendations covering wound cleansing, pain relief, instructing the patient, various dressings and the organisational aspects of wound care. The guideline recommendations include not to cleanse wounds that are primarily closed, to cleanse acute open wounds with clean tap water, to use the WHO pain ladder as the basis for the choice of analgesics for continuous wound pain, to administer lidocaine or prilocaine for localized pain relief during manipulation, not to cover primarily closed wounds with dressings, to use simple dressings for open wounds and to give the patient clear instructions. The guideline also advises about wound registration, documentation and hand-over of wound care, and recommends making clear agreements about referrals and responsibilities.

  5. Validity of the Fine Motor Area of the 12-Month Ages and Stages Questionnaire in Infants Following Major Surgery

    Science.gov (United States)

    Smith, Cally; Wallen, Margaret; Walker, Karen; Bundy, Anita; Rolinson, Rachel; Badawi, Nadia

    2012-01-01

    The Ages and Stages Questionnaires (ASQ) are parent-report screening tools to identify infants at risk of developmental difficulties. The purpose of this study was to examine validity and internal reliability of the fine motor developmental area of the ASQ, 2nd edition (ASQ2-FM) for screening 12-month-old infants following major surgery. The…

  6. Stereotaxic surgery for excitotoxic lesion of specific brain areas in the adult rat.

    Science.gov (United States)

    Kirby, Elizabeth D; Jensen, Kelly; Goosens, Ki A; Kaufer, Daniela

    2012-07-19

    Many behavioral functions in mammals, including rodents and humans, are mediated principally by discrete brain regions. A common method for discerning the function of various brain regions for behavior or other experimental outcomes is to implement a localized ablation of function. In humans, patient populations with localized brain lesions are often studied for deficits, in hopes of revealing the underlying function of the damaged area. In rodents, one can experimentally induce lesions of specific brain regions. Lesion can be accomplished in several ways. Electrolytic lesions can cause localized damage but will damage a variety of cell types as well as traversing fibers from other brain regions that happen to be near the lesion site. Inducible genetic techniques using cell-type specific promoters may also enable site-specific targeting. These techniques are complex and not always practical depending on the target brain area. Excitotoxic lesion using stereotaxic surgery, by contrast, is one of the most reliable and practical methods of lesioning excitatory neurons without damaging local glial cells or traversing fibers. Here, we present a protocol for stereotaxic infusion of the excitotoxin, N-methyl-D-aspartate (NMDA), into the basolateral amygdala complex. Using anatomical indications, we apply stereotaxic coordinates to determine the location of our target brain region and lower an injection needle in place just above the target. We then infuse our excitotoxin into the brain, resulting in excitotoxic death of nearby neurons. While our experimental subject of choice is a rat, the same methods can be applied to other mammals, with the appropriate adjustments in equipment and coordinates. This method can be used on a variety of brain regions, including the basolateral amygdala, other amygdala nuclei, hippocampus, entorhinal cortex and prefrontal cortex. It can also be used to infuse biological compounds such as viral vectors. The basic stereotaxic technique could

  7. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  8. [Preoperative direct cortical and sub-cortical electric stimulation during cerebral surgery in functional areas].

    Science.gov (United States)

    Duffau, H; Capelle, L; Sichez, J P; Bitar, A; Faillot, T; Arthuis, F; Van Effenterre, R; Fohanno, D

    1999-09-01

    Indications of surgical treatment for lesions in functional cerebral areas depend on the ratio between the definitive neurological deficit and the beneficial effect of resection. Detection of eloquent cortex is difficult because of important individual variability. Peroperative direct cortical and subcortical electrical stimulations (DCS) provide the most precise and reliable method currently available allowing identification and preservation of neurons essential for motricity, sensitivity++ and language. We report our preliminary experience with DCS in surgery of intracerebral infiltrative tumors with a consecutive series of 15 patients operated from November 96 through September 97 in our institution. Presenting symptoms in the 15 patients (8 males, 7 females, mean age 43 years) were seizures in 11 cases (73%) and neurological deficit in 4 cases (27%). Clinical examination was normal in 11 patients and revealed hemiparesia in 4. Magnetic resonance imaging (MRI) with three-dimensional reconstruction showed a precentral tumor in 10 cases, central lesion in one patient, postcentral lesion in two cases, right insular tumor (non-dominant hemisphere) in one case. All patients underwent surgical resection using DCS with detection in 13 cases of motor cortex and subcortical pathways under genera anesthesia, in one case of somatosensory area under local anesthesia, and in one case of language areas also under local anesthesia. The tumor was recurrent in two patients had been operated earlier but without DCS. Resection, verified by postoperative MRI, was total in 12 cases (80%) and estimated at 80% in 3 patients. Histological examination revealed an infiltrative glioma in 12 cases (8 low grade astrocytomas, 3 low grade oligodendrogliomas, and one anaplastic oligodendroglioma), and metastases in 3 cases. Eight patients had no postoperative deficit, while the other 7 patients were impaired, with, in all cases except one, complete recovery in 15 days to 2 months. Direct

  9. Outcome of cataract surgery in rural areas of Kaduna State, Nigeria

    African Journals Online (AJOL)

    Aim: To evaluate the visual outcome of all patients who had cataract surgery with ... like striate keratopathy/corneal oedema (18.3%), cortical reminant .... Bio data and clinical data on each patient for cataract surgery were entered into the ...

  10. COMPARATIVE EVALUATION OF PROPOFOL KETAMINE AND PROPOFOL FENTANYL IN DAY CARE SURGERIES

    Directory of Open Access Journals (Sweden)

    Brajesh

    2014-09-01

    Full Text Available To find the ideal drug combinations which can be used during day care surgeries and procedures. AIMS: This study was conducted. To evaluate and compare the efficacy, and haemodynamic stability of ketamine and fentanyl combination with propofol. To compare the incidence of side effects. To compare the time of awakening and recovery time. To compare the discharge criteria in both groups. METHODS: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I and II, were divided into two groups of 25 each. They underwent elective surgery of approximately 1 hour duration. Group I received Propofol-ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system and discharge status (by modified post anaesthetic discharge scoring system were recorded and compared in two groups. RESULTS: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol-fentanyl group as compared to Propofol-ketamine group. The recovery time in group I was longer than group II. Discharge criteria is significantly earlier in group II. CONCLUSION: Both Profol-ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia.

  11. Anatomical and Visual Outcome following Macular Hole Surgery at a Tertiary Eye Care Centre in Nepal

    Directory of Open Access Journals (Sweden)

    R Thapa

    2011-07-01

    Full Text Available Introduction: Macular hole (MH leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal. Methods: This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8 from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT at six weeks, three months and at the last follow-up following surgery were recorded. Results: A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D. Idiopathic macular hole comprised of 31 cases (86.1 % and traumatic of five cases (13.9 %. The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 % at six weeks and in 28 cases (77.8% at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 % than in the traumatic (60 % and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases. Conclusions: The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic. Keywords: Anatomical success, macular hole, perfluoropropane gas, visual acuity, vitrectomy

  12. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

  13. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Beishuizen Albertus

    2011-05-01

    Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

  14. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    Science.gov (United States)

    2011-01-01

    Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU). Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA) score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52%) of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 4,683 mL) were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery. PMID:21624108

  15. Decentralization of care for adults with congenital heart disease in the United States: a geographic analysis of outpatient surgery.

    Directory of Open Access Journals (Sweden)

    Bryan G Maxwell

    Full Text Available BACKGROUND: Guidelines recommend that adults with congenital heart disease (CHD undergo noncardiac surgery in regionalized centers of expertise, but no studies have assessed whether this occurs in the United States. We hypothesized that adults with CHD are less likely than children to receive care at specialized CHD centers. METHODS: Using a comprehensive state ambulatory surgical registry (California Ambulatory Surgery Database, 2005-2011, we calculated the proportion of adult and pediatric patients with CHD who had surgery at a CHD center, distance to the nearest CHD center, and distance to the facility where surgery was performed. RESULTS: Patients with CHD accounted for a larger proportion of the pediatric population (n = 11,254, 1.0% than the adult population (n = 10,547, 0.07%. Only 2,741 (26.0% adults with CHD had surgery in a CHD center compared to 6,403 (56.9% children (p<0.0001. Adult CHD patients who had surgery at a non-specialty center (11.9 ± 15.4 miles away lived farther from the nearest CHD center (37.9 ± 43.0 miles than adult CHD patients who had surgery at a CHD center (23.2 ± 28.4 miles; p<0.0001. Pediatric CHD patients who had surgery at a non-specialty center (18.0 ± 20.7 miles away lived farther from the nearest CHD center (35.7 ± 45.2 miles than pediatric CHD patients who had surgery at a CHD center (22.4 ± 26.0 miles; p<0.0001. CONCLUSIONS: Unlike children with CHD, most adults with CHD (74% do not have outpatient surgery at a CHD center. For both adults and children with CHD, greater distance from a CHD center is associated with having surgery at a non-specialty center. These results have significant public health implications in that they suggest a failing to achieve adequate regional access to specialized ACHD care. Further studies will be required to evaluate potential strategies to more reliably direct this vulnerable population to centers of expertise.

  16. Case Control Analyses of Acute Endophthalmitis after Cataract Surgery in South India Associated with Technique, Patient Care, and Socioeconomic Status

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    Taraprasad Das

    2012-01-01

    Full Text Available Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (=0.054. Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety.

  17. Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital.

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    Judith Rodríguez-García

    Full Text Available Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI. According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS distribution in the hospital setting.The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES patients and to compare the clinical and anthropometric characteristics and length of stays (LOS between obese and non-obese patients and between patients with and without NI.We conducted a cross-sectional study with a sample (n = 82 adult ES patients (21-59 years old who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test, and the association between preoperative risk-factors and NI was evaluated using odds ratios.The distribution of subjects by NS category was: underweight (3.66%, normal-weight (28.05%, overweight (35.36%, and obese (32.93%. The prevalence of NI was 14.63%. The LOS was longer (p<0.001 for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  20. Long-term surgical results of supplementary motor area epilepsy surgery.

    Science.gov (United States)

    Alonso-Vanegas, Mario A; San-Juan, Daniel; Buentello García, Ricardo M; Castillo-Montoya, Carlos; Sentíes-Madrid, Horacio; Mascher, Erika Brust; Bialik, Paul Shkurovick; Trenado, Carlos

    2017-02-03

    OBJECTIVE Supplementary motor area (SMA) epilepsy is a well-known clinical condition; however, long-term surgical outcome reports are scarce and correspond to small series or isolated case reports. The aim of this study is to present the surgical results of SMA epilepsy patients treated at 2 reference centers in Mexico City. METHODS For this retrospective descriptive study (1999-2014), 52 patients underwent lesionectomy and/or corticectomy of the SMA that was guided by electrocorticography (ECoG). The clinical, neurophysiological, neuroimaging, and pathological findings are described. The Engel scale was used to classify surgical outcome. Descriptive statistics, Student t-test, and Friedman, Kruskal-Wallis, and chi-square tests were used. RESULTS Of these 52 patients, the mean age at epilepsy onset was 26.3 years, and the mean preoperative seizure frequency was 14 seizures per month. Etiologies included low-grade tumors in 28 (53.8%) patients, cortical dysplasia in 17 (32.7%) patients, and cavernomas in 7 (13.5%) patients. At a mean follow-up of 5.7 years (range 1-10 years), 32 patients (61%) were classified as Engel Class I, 16 patients (31%) were classified as Engel Class II, and 4 (8%) patients were classified as Engel Class III. Overall seizure reduction was significant (p = 0.001). The absence of early postsurgical seizures and lesional etiology were associated with the outcome of Engel Class I (p = 0.05). Twenty-six (50%) patients had complications in the immediate postoperative period, all of which resolved completely with no residual neurological deficits. CONCLUSIONS Surgery for SMA epilepsy guided by ECoG using a multidisciplinary and multimodality approach is a safe, feasible procedure that shows good seizure control, moderate morbidity, and no mortality.

  1. Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules.

    Science.gov (United States)

    Fügener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred

    2016-03-15

    With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.

  2. Outcomes of surgical site infections in orthopedic trauma surgeries in a tertiary care centre in India

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    N Rajkumari

    2014-01-01

    Full Text Available Background: Surgical site infections (SSIs still cause significant morbidity and mortality despite advances in trauma care. We have studied in this paper the rate of SSIs, their outcomes in patients undergoing interventions for trauma and SSI trends in developing countries. Materials and Methods: A 16-month study (May, 2011- August, 2012 was carried out. Patients undergoing interventions for orthopedic trauma were followed and assessed for SSIs and their outcomes and antimicrobial sensitivity patterns of the micro-organisms isolated were noted and correlated. Results: A total of 40 (4.4% confirmed cases of SSIs were identified among 852 patients of orthopedic trauma. Based on the new CDC criteria, after ruling out cellulitis, only 24 (2.6% were found to have SSIs. A total of 12.5% of the SSIs were detected during follow-up. Acinetobacter baumannii was the predominant organism as also Staphylococcus aureus. Outcomes observed included changes in antibiotic regime, revision surgery, readmission to hospital and deaths. Conclusion: SSI is prevalent in orthopaedic trauma patients and an active surveillance program will help in early management and prevention.

  3. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.

  4. 新生儿术后监护%Intensive Care for Newborns After Surgery

    Institute of Scientific and Technical Information of China (English)

    伍连康; 余家康; 潘韶芳; 曾其毅

    1993-01-01

    1989年1月~1992年1月,对77例新生儿进行术后监护处理.低温、呼吸功能不全、循环障碍和酸碱平衡失调为术后主要的病理生理改变.本组17例患儿(22%)分别死于感染、吸入性肺炎和呼吸功能不全.我们认为术后广泛使用呼吸机,加强抗感染治疗以及营养支持是提高新生儿外科疗效的关键环节.%From Jan. 1989 to Jan. 1992, 77 newborns were monitored in neonatal intensive care unit following surgical procedures. The main pathophysiologic changes were as follows: low body temperature, respiratory and circulation insufficiency, and electrolyte imbalance. Seventeen of them (22%) died of infection, aspiration pneumonia or respiratory failure. The authors emphasize thatmechanical ventilation, antibiotics and nutritional support would play an important role in decreasing mortality and morbility of newborns after surgery.

  5. Increasing access to cataract surgery in a rural area--a support strategy.

    Science.gov (United States)

    Malhotra, R; Uppal, Y; Misra, A; Taneja, D K; Gupta, V K; Ingle, G K

    2005-01-01

    The objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.

  6. Magnetic resonance diffusion tensor imaging with fluorescein sodium dyeing for surgery of gliomas in brain motor functional areas

    Institute of Scientific and Technical Information of China (English)

    LIU Jia-gang; YANG Shuai-feng; LIU Yan-hui; WANG Xiang; MAO Qing

    2013-01-01

    Background Tumor surgery in brain motor functional areas remains challenging.Novel techniques are being developed to gain maximal and safe resection for brain tumor surgery.Herein,we assessed the magnetic resonance diffusion tensor imaging (MR-DTI) and fluorescein sodium dyeing (FLS) guiding technique for surgery of glioma located in brain motor functional areas.Methods Totally 83 patients were enrolled according to our inclusion and exclusion criteria (56 patients in experimental group,27 patients in control group).In the experimental group,the surgical approach was designed by DTI imaging,which showed the relationship between the tumor and motor tract.The range of resection in the operation was determined using the FLS-stained area,which recognized the tumor and its infiltrated tissue.The traditional routine method was used in the control group.Postoperatively,all patients underwent enhanced brain MRI within 72 hours to ascertain the extent of resection.Patients were followed in our outpatient clinic over 6-24 months.Neurological deficits and Karnofsky scoring (KPS) were evaluated.Results There were no significant differences in balance test indexes of preoperative data (sex,age,lesion location and volume,and neurological deficits before operation) and diagnosis of histopathology between the two groups.There was a trend in the experimental group for greater rates of gross total resection (80.4% vs.40.7%),and the paralysis rate caused by surgery was lower in experimental (25.0%) vs.control (66.7%) groups (P <0.05).The 6-month KPS in the low-grade and high-grade gliomas was 91±11 and 73±26,respectively,in the experimental group vs.82±9 and 43±27,respectively,in the control group (P <0.05 for both).Conclusions MR-DTI and FLS dye guiding for surgery of glioma located in brain motor functional areas can increase the gross total resection rate,decrease the paralysis rate caused by surgery,and improve patient quality of life compared with traditional

  7. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

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    de Souza Luiz

    2009-07-01

    Full Text Available Abstract Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. Methods A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%, with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age Conclusion Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

  8. INGUINAL HERNIA SURGERY UNDER LOCAL ANAESTHESIA, AS DAY CARE SURGERY AND COMPARISON AMONG THREE GROUP OF PATIENTS CLASSIFIED ACCORDING TO TYPE OF MESH USED

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    Arvind

    2015-06-01

    Full Text Available BACKGROUND: Inguinal hernia repair is one of the most commonly performed operations worldwide . This study was done to evaluate , local anesthesia as choice of procedure for inguinal hernia as day care surgery including both regular & comorbidity associated patients , to know which mesh is suitable smallpore ( H eavy weight or largepore ( L igh t weight and to know if use of absorbable suture is better than non - absorbable suture for fixation of mesh. METHODS: We prospectively studied 69 patients with a primary unilateral inguinal hernia. The study group was randomized to Lichtenstein repair afte r taking full informed consent. Pain was assessed by visual analogue scale , Quality of life was assessed by responses to a health questionnaire administered to post - operative patients . RESULTS: The highest contraction rate was found in polypropylene small pore mesh (28.76% , followed by polypropylene large pore mesh (23.9% and the least contraction seen in knitted composite mesh (17.2%. Quality of life was assessed at 1 month and 3 month have shown significant difference among three groups. CONCLUSION: Mos t of the inguinal hernia surgery can be carried out smoothly in local anesthesia , as day care procedure. It is choice of procedure also in patients with comorbidity. Use of absorbable suture for Lichtenstein hernia repair did not affect recurrence rate. Qu ality of life is better with knitted composite group , than pp large pore group , than Polypropylene small pore mesh.

  9. Rollende arztpraxis - first results of an ambulant mobile care model for rural areas.

    Science.gov (United States)

    Schwartze, Jonas; Wolf, Klaus-Hendrik; Von Bargen, Tobias; Rochon, Maike; Wagner, Markus; Bannenberg, Uwe; Drews, Markus; Fischer, Thomas; Hellwig, Torben; Hofmann, Stefan; Höft-Budde, Petra; Jäger, Ralf; Lorenz, Stefan; Naumann, Ruth; Plischke, Maik; Reytarowski, Jörg; Richter, Constanze; Steinbrügge, Christina; Ziegenspeck, Anja; Von Ingelheim, Julius; Haux, Reinhold

    2014-01-01

    German medical care is going to suffer from a decreasing number of general practitioners due to demographic change. We study if ambulatory care in rural areas can be complementary ensured by a mobile care unit. A medical care van - the "rolling medical practice" (RMP) - has been constructed based on care scenarios created for rural communities in northern Germany. Performance and acceptance of the RMP is evaluated by constant monitoring of anonymized medical documentation and questionnaires. The RMP is visiting six villages on two days a week in a three-week interval. It is constructed from a standard van with a custom box body fully equipped for general care needs. Actually treated care cases meet expectations and are acute as well as chronicle symptoms. Case numbers range from 6 to 50 visits in 5 month. We showed that almost full ranged mobile medical care, as supplement to general medical supply is possible.

  10. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

    Science.gov (United States)

    Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

    2015-10-01

    Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted

  11. Measuring the quality of melanoma surgery - Highlighting issues with standardization and quality assurance of care in surgical oncology.

    Science.gov (United States)

    Pasquali, S; Sommariva, A; Spillane, A J; Bilimoria, K Y; Rossi, C R

    2017-03-01

    In an attempt to ensure high standards of cancer care, there is increasing interest in determining and monitoring the quality of interventions in surgical oncology. In recent years, this has been particularly the case for melanoma surgery. The vast majority of patients with melanoma undergo surgery. Usually, this is with combinations of wide excision, sentinel lymph node biopsy and lymphadenectomy. The indications for these procedures evolved during a time when no effective systemic adjuvant therapy was available, and whilst the rationale has been sound, the justification for differences in extent and thoroughness has generally been supported by inadequate or low-level evidence. This has led to a substantial variation among melanoma centres or even among surgeons within a centre in how these procedures are done. With recent rapid progress in the efficacy of systemic treatments that are impacting on overall survival, the prospect of long-term survival in these previously high risk patients means that more than ever long-term locoregional control of melanoma is imperative. Furthermore, the understanding of effects of systemic therapy on locoregional disease will only be interpretable if surgeons use standardized, high quality techniques. This article focuses on standardization and evolution of quality indicators for melanoma surgery and how these might have a positive impact on patient care. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  12. Cytoreductive surgery for peritoneal malignancies--development of standards of care for the community.

    Science.gov (United States)

    Esquivel, Jesus

    2007-07-01

    Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) continue to play an increasing role in the management of peritoneal surface malignancies of gastrointestinal origin. The prognosis of patients and the responses to cytoreductive surgery and HIPEC depend on the histology, the degree of malignant transformation, the adequacy of the cytoreductive surgery, and the response to systemic therapy. Continuous interaction between medical and surgical oncologists is needed to identify the most appropriate patients for and the most efficient sequence of the available therapeutic modalities.

  13. Influence of Hospital Volume Effects and Minimum Caseload Requirements on Quality of Care in Pancreatic Surgery in Germany.

    Science.gov (United States)

    Krautz, Christian; Denz, Axel; Weber, Georg F; Grützmann, Robert

    2017-05-01

    Numerous international studies have identified hospital volume as significant independent variable of death following pancreatic surgery. Most of these studies were limited to regions of countries or portions of a national population and did not include data on volume-outcome effects in Germany. The Medline database was systematically searched to identify studies that analyzed volume-outcome relationships and effects of minimum caseload requirements on outcomes of pancreatic surgery in Germany. Recent observational studies utilizing German hospital discharge data confirmed that patients undergoing pancreatic surgery in Germany also have better outcomes when treated in facilities with high annual caseloads. Besides a decreased risk of in-hospital mortality, there is also a reduced risk of 1-year mortality in high-volume hospitals. In addition, there is evidence that adherence to already existing minimum caseload requirements reduces morbidity and mortality of pancreatic surgery in Germany. As a result of an insufficient centralization in the recent past, however, a large proportion of hospitals that perform pancreatic surgery still do not meet minimum caseload requirements. Specific measures (i.e. sanctions for failure to achieve minimum volumes) that initiate a sufficient centralization process without threatening patient access to surgical care are needed.

  14. Evaluating the Effect of Cardiac Rehabilitation Care Plan on Quality of Life of Patients Undergoing Coronary Artery Bypass Graft Surgery

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    Seyedeh Zahra Masoumi

    2017-05-01

    Full Text Available Introduction: Cardiovascular surgeries are among the conventional surgeries aimed at increasing the survival rate and improving the quality of life of patients. This study aimed to evaluate the effect of cardiac rehabilitation on quality of life of patients undergoing Coronary artery bypass graft (CABG surgery.Methods: This was a semi-experimental study performed on 160 patients undergoing CABG surgery. The rehabilitation program was carried out for 13 weeks (three sessions per week in 40 sessions, six weeks after the CABG surgery. The MacNew standard questionnaire and the general health questionnaire (S-f 36 were completed before the beginning of rehabilitation sessions as well as after completion of these sessions by patients.Results: According to the results, the quality of life of patients significantly increased in the physical and emotional areas after the rehabilitation program. The results also indicated that there was a significant difference between various levels of research in the physical functioning variables, dysfunction due to physical health, dysfunction due to emotional health, energy/fatigue of individuals, emotional well-being, social functioning, pain, and general health.Conclusions: The present results indicated the improved quality of life of patients in all the areas after cardiac rehabilitation intervention, compared to before that. Therefore, paying more attention to cardiac rehabilitation is necessary due to its positive effects on increasing the quality of life of patients.

  15. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

    Science.gov (United States)

    Ribeiro, Eleonora R O; Guimarães, Alzira Maria D N; Bettiol, Heloísa; Lima, Danilo D F; Almeida, Maria Luiza D; de Souza, Luiz; Silva, Antônio Augusto M; Gurgel, Ricardo Q

    2009-07-22

    The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

  16. Attitudes of Parents and Health Care Workers to Major Surgery for High-Risk Preterm Infants.

    Science.gov (United States)

    Lam, Hugh Simon; Sit, Tony; Chau, Chi Lok; Tam, Yuk Him; Cheung, Hon Ming; Wong, Samuel Po Shing; Ng, Pak Cheung

    2016-10-01

    To assess preferences of health care workers (HCWs) and parents of term and preterm infants to adverse health outcomes, and how perceived surgical mortality influences decision-making. A total of 536 participants (157 HCWs, 201 parents of term infants, and 178 parents of preterm infants) were recruited to take part in a structured interview. Preferences related to treatment of a critically ill preterm infant with necrotizing enterocolitis were measured by health state rank permutation analysis and pivotal risk analysis. Between-group and subgroup comparisons were performed. HCWs rank adverse health states less favorably than parents of preterm infants, consistently ranking 2 of the most adverse health states worse than death. Pivotal risk values of HCWs for all health states were consistently the lowest of the 3 groups. High operative mortality was associated uniformly with reduction in pivotal risks for all groups both in favorable and adverse health states. Subgroup analyses revealed significant discrepancies in preferences between fathers and mothers as well as doctors and nurses. Regular religious practice was significantly associated with increased pivotal risks in parental subgroups. As discrepancies in health state preferences existed between subgroups (ie, doctors vs nurses, mothers vs fathers) and perceived operative mortality consistently biased parental and HCW health state preferences, we recommend that HCWs should first identify differences regarding patient management before interviewing the parents together. HCWs should be aware of inadvertently biasing parents when discussing the risks and outcomes of surgery in conjunction with the overall long-term prognosis of the underlying condition. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. 76 FR 50540 - Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas

    Science.gov (United States)

    2011-08-15

    ... AFFAIRS Pilot Program of Enhanced Contract Care Authority for Veterans in Highly Rural Areas AGENCY... implementing Sec. 403 of Public Law (Pub. L.) 110-387, ``Veterans' Mental Health and Other Care Improvements Act of 2008,'' which requires VA to establish a pilot program to contract with non-VA health...

  18. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

    OpenAIRE

    de Souza Luiz; Almeida Maria; Lima Danilo DF; Bettiol Heloísa; Guimarães Alzira Maria DN; Ribeiro Eleonora RO; Silva Antônio; Gurgel Ricardo Q.

    2009-01-01

    Abstract Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance ...

  19. The uniform as a representative object in health care area

    Directory of Open Access Journals (Sweden)

    Eliecília de Fátima Martins

    2011-09-01

    Full Text Available It inserts in the scope of the studies of thematerial culture, setting the uniform in Health Carearea as an object of study. It is aimed to analyze thesignifi cance of this clothing as an element which ispresent in the formation of the image of the companiesin human relations professionals and corporateidentity. It is based in bibliographical research,costume analysis and interview. It is discussed howthese artefacts are noticed and interpreted in theinternal and external relations to the professionalsand the use of the uniform as a contradictoryform of homogenization and of a distinction of socialclasses. It concludes that for the company, thiscostume represents a group of concepts, statementsand explanations; it is interpreted as derived of theidentity of the area. For the professionals of the area,it attributes characteristics and traits of individualityof this group and at the same time becomes asymbol of status and social diff erentiation and segregationinside of the own group according to thefunction or position that the individual occupies.

  20. [Plastic surgery defect coverage in the area of the pelvis and trunk].

    Science.gov (United States)

    Germann, G; Erdmann, D; Sauerbier, M; Bickert, B

    1997-05-01

    Complex defects of the trunk and pelvic region are rare, but are mostly the sequelae of serious conditions. Stable soft tissue coverage after radical debridement of all avital tissue may be of vital importance for the patient. The article will demonstrate the options of plastic surgery procedures that should be known by the general surgeon to be eventually integrated into a interdisciplinary therapeutic concept.

  1. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial

    OpenAIRE

    Peul, Wilco; Hout, Wilbert; Brand, René; Thomeer, Raph; Koes, Bart

    2008-01-01

    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions: Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed. Main outcome measures: Scores from Roland disability questionnaire for sciatica, visua...

  2. Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review

    Directory of Open Access Journals (Sweden)

    Grema Umar Sambo

    2015-01-01

    Full Text Available Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from July, 2009 to July, 2014. Results: There were 1067 patients who had ear, nose, and throat surgeries within the period under review, out of which 68 were ear surgeries. Prevalence was 6.37%, there were 25 (37% males and 43 (63% females, male: female 1:1.7. Age ranged from 1 to 58 years, mean age 21 ± 6 years. Chronic suppurative otitis media was the most common diagnosis 39 (57.4% and indication for tympanoplasty 31 (46.6%. Meatocanaloplasty was the least with 2 (2.9%, mastoidectomy 7 (10.3%, myringotomy and grommet insertion 11 (16.2%, excisional biopsy 7 (10.3%, foreign body removal 4 (5.90%, tympanomastoidectomy 3 (4.40%, and pinnaplasty 3 (4.40%. Forty-one (60.3% achieved resolution of symptoms while 8 (11.8% had persistence of symptoms. One (1.5% had revision surgery. The success rate is about 60.3% within the period under review. Postoperative complications (facial nerve paralysis, persistence discharge from the mastoid cavity, worsened deafness, postauricular fistula were seen in 14 (20.6%. While 4 (5.9% were lost to follow-up. Conclusion: Ear surgeries are still underdeveloped when compared to nose and throat surgeries in our center. Complication (chronic suppurative otitis media was the most common indication for ear surgery. Provision of adequate training facilities, especially in the field of otology and review of the training curriculum for otorhinolaryngology residency in Nigeria is indispensable.

  3. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation : cost utility analysis alongside a randomised controlled trial

    NARCIS (Netherlands)

    Hout, van den W.B.; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.W.M.

    2008-01-01

    Objective: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. Design: Cost utility analysis alongside a randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with sciati

  4. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial.

    NARCIS (Netherlands)

    Hout, W.B. van den; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.

    2008-01-01

    OBJECTIVE: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. DESIGN: Cost utility analysis alongside a randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with sciati

  5. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    2.65-11.99. No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66-1.43. The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes.Bariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese.

  6. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    Science.gov (United States)

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    hypertension, with a HR of 5.64 (95% CI 2.65–11.99). No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66–1.43). The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes. Conclusions Bariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese. PMID:26694640

  7. 内镜下颅底手术体会%Clinical experience with nasendoscopic surgery in nose-skull base area

    Institute of Scientific and Technical Information of China (English)

    包小庆; 谢宏武

    2011-01-01

    Objective To summarize the clinical experience with nasendoscopic surgery in nose-skull base area and explore appropriate surgical technique for various kinds lesion in this area based on a retrospective clinical analysis. Methods Included in this study were 15 patients with various kinds of nose-skull base disease, all being treated by nasendoscopic surgery during the period from Jul., 2003 to Aug., 2011. A retrospective study was carried out among them, with their clinical data analyzed carefully to sum up our experience with this kind of surgery. Results All these operations were carried out under nasal endoscope successfully. Among them, 7 with pituitary adenoma were seen with their disordered endocrine symptoms and impaired vision function improved following the surgery, 3 with traumatic cerebrospinal rhinorrhea were cured successfully without symptoms reoccurred after die operation, and 5 with traumatic optic neuropathy had improved visual function at various degrees respectively after transnasal endoscopic optic canal decompression. Among these cases with traumatic optic neuropathy, one was complicated with cerebrospinal rhinorrhea following the operation but the lesion was cured with conservative treating procedures after the primary surgery. Conclusions Transnasal endoscopic surgery holds many advantages for the treatment of lesions involving the area of nose-skull base, such as minimal invasive during the operation, quicker recovery course following the operation and fewer chance with possible operative complications. It is very important to identify the surgical anatomical landmarks exactly during the operation and to reconstruct the tissue defects in skull base properly for ensuring the safety and efficacy of the surgery.%目的 总结内镜下颅底手术的方法和临床经验.方法 回顾性分析2003年7月~2011年8月在鼻内镜下完成的鼻颅底区域手术15例临床资料,探讨鼻颅底手术的相关技术与

  8. Parent education discharge instruction program for care of children at home after cardiac surgery in Southern India.

    Science.gov (United States)

    Staveski, Sandra L; Parveen, V P; Madathil, Sai B; Kools, Susan; Franck, Linda S

    2016-08-01

    Introduction In many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children's care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India. Materials and methods A quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program's implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme's implementation. Both nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme's implementation (T1=24.4±2.89; T2=27.4±1.55; p0.05) after the programme's implementation. Nurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.

  9. e-Education in paediatric surgery: a role for recorded seminars in areas of low bandwidth in sub-Saharan Africa.

    Science.gov (United States)

    Hadley, G P; Mars, M

    2011-04-01

    There is a shortage of surgeons in Africa, and this shortage is particularly acute in paediatric surgery with most paediatric patients being cared for by general surgeons. The use of information technology to augment teaching in paediatric surgery in Africa is appealing but often unsuccessful due to the costs involved and a lack of bandwidth. A simple solution is needed to allow sharing of teaching sessions that are normally conducted by videoconference in areas in which bandwidth is adequate. Weekly paediatric surgical interactive seminars that are regularly shared by videoconference by three centres in South Africa have been recorded onto DVDs. These have been bundled into monthly packages and couriered to four medical schools in East and Central Africa. Recipients have been at liberty to use them as they saw fit. After 6 months, a survey was conducted to determine the usefulness of the exercise. At all recipient sites, the seminars were used as part of the teaching of general surgical trainees and paediatric surgical fellows at those medical schools with appropriate training programmes. Three of the four schools used the seminars in undergraduate courses. All regarded the seminars as useful and all but one as of adequate visual and sound quality. The in-house teaching at the medical school in Durban is now shared by over 140 surgical trainees and students in four countries in which a lack of bandwidth precludes videoconferencing, and this low-tech low-cost solution has proved effective in resource-poor settings.

  10. [The research of biodegradation of a composite material used in reconstructive and reparative surgery of maxillofacial area].

    Science.gov (United States)

    Malanchuk, V O; Astapenko, O O; Halatenko, N A; Rozhnova, R A

    2013-09-01

    Dates about the research of biodegradation of epoxy-polyurethane composite material used in reconstructive and reparative surgery of maxillofacial area are reflected in the article. Was founded: 1) notable biodegradation of species from epoxy-polyurethane composition in the term of observation up to 6 months was not founded. That testifies their preservation of physical and mechanical properties. 2) founded, that in species from epoxy-polyurethane composition, which contain levamisole, processes of biodegradation are faster then in species from pure epoxy-polyurethane composition and in species from epoxy-polyurethane composition with hydroxyapatite; 3) material from epoxy-polyurethane composition, which contains levamisole and hydroxyapatite, stays in biological environment in small quantity of petty fragments during the incubation in term of 2 years. So, it biodegrades practically totally. Authors suggest on the basis of achieved information, that the use of epoxy-polyurethane constructions that biodegrade, is pertinently in reconstructive maxillofacial surgery.

  11. Fast-track surgery-an update on physiological care principles to enhance recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2011-01-01

    INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of mo...... of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology....

  12. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by restricting the ... Online Education Directory Search Patient Learning Center Bariatric Surgery ... Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  13. Cavus Foot Surgery

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

  14. Nursing role to improve care to infarct patients and patients undergoing heart surgery: 10 years' experience.

    Science.gov (United States)

    Wit, M A M; Bos-Schaap, A J C M; Hautvast, R W M; Heestermans, A A C M; Umans, V A W M

    2012-01-01

    The nurse practitioner may be the ideal healthcare worker to create a new environment and may facilitate in the process of expediting discharge and improving patient safety. They can play an intermediary role between the consultants, nurses and patients, thereby combining the aspects of care (nursing) and cure (physicians). We describe the contribution and role of the nurse practitioner in a teaching hospital and provide an overview of the changes in care and cure that were facilitated by two nurse practitioners in the treatment of cardiac surgery patients or non-complicated acute coronary syndrome patients. The nurse-led clinic for postoperative patients has registered 1967 patients in the past 10 years. These patients were transferred at a mean of 5.5 days after their bypass operation. All patients had an uneventful clinical course in our hospital and were discharged alive. The period between discharge and outpatient clinic visit could be set at 4 weeks. The post-acute coronary syndrome (ACS) group included 1236 patients. Mortality in this patient cohort was 4% while 0.4% of these patients experienced a re-myocardial infarction. Additional surgery was needed in only 2% of these stable post-infarction patients. The mean length of stay was 5.9 ± 14.5 days. This observational study confirms that a nurse-led postoperative care unit and post-ACS care unit is feasible and effective for the treatment of patients returning from cardiac surgery or transferred after uncomplicated ACS to a general cardiology ward.

  15. Management of Epilepsy in Resource-Limited Areas: Establishing an Epilepsy Surgery Program in Iran

    Science.gov (United States)

    Asadi-Pooya, Ali A; Ashjazadeh, Nahid; Kamgarpour, Ahmad; Taghipour, Mousa; Rakei, Seyed Mohamad; Farazdaghi, Mohsen; Inaloo, Soroor; Bagheri, Mohammad Hadi; Razmkon, Ali; Zare, Zahra

    2014-01-01

    Background Of about 40 million people with epilepsy, who live in developing countries, the majority do not receive appropriate treatment. Nonetheless, there are striking disparities among the so-called developing countries, however generally speaking, access to and availability of epilepsy management programs in developing countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated, appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon the accurate identification of good surgical candidates based on the available resources and technologies without jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program in Iran, despite all short-comings and limitations and try to provide some answers to those challenges, which helped us establish our program. PMID:25250284

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

    Science.gov (United States)

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

    2009-03-01

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

  17. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

    Science.gov (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  18. Healthcare PANs: Personal Area Networks for trauma care and home care

    NARCIS (Netherlands)

    Jones, V.M.; Bults, R.G.A.; Konstantas, D.; Vierhout, P.A.M.

    2001-01-01

    The first hour following the trauma is of crucial importance in trauma care. The sooner treatment begins, the better the ultimate outcome for the patient. Generally the initial treatment is handled by paramedical personnel arriving at the site of the accident with an ambulance. There is evidence to

  19. Creating healing intensive care unit environments: physical and psychological considerations in designing critical care areas.

    Science.gov (United States)

    Bazuin, Doug; Cardon, Kerrie

    2011-01-01

    A number of elements contribute to a healing ICU environment. The layout of a critical care unit helps create an environment that supports caregiving, which helps alleviate a host of work-related stresses. A quieter environment, one that includes family and friends, dotted with windows and natural light, creates a space that makes people feel balanced and reassured. A healing environment responds to the needs of all the people within a critical care unit-those who receive or give care and those who support patients and staff. Critical care units should be designed to focus on healing the body, the mind, and the senses. The design and policies of that department can be created in such a way to provide a sense of calm and balance. The physical environment has an impact on patient outcomes; the psychological environment can, too. A healing ICU environment will balance both. The authors discuss the ways in which architecture, interior design, and behavior contribute to a healing ICU environment.

  20. Healthcare PANs: Personal Area Networks for trauma care and home care

    NARCIS (Netherlands)

    Jones, Valerie M.; Bults, Richard G.A.; Konstantas, D.; Vierhout, P.A.M.

    2001-01-01

    The first hour following the trauma is of crucial importance in trauma care. The sooner treatment begins, the better the ultimate outcome for the patient. Generally the initial treatment is handled by paramedical personnel arriving at the site of the accident with an ambulance. There is evidence to

  1. Planning and Providing End-of-life Care in Rural Areas

    Science.gov (United States)

    Wilson, Donna M.; Justice, Christopher; Sheps, Sam; Thomas, Roger; Reid, Pam; Leibovici, Karen

    2006-01-01

    Context: Approximately 20% of North Americans and 25% of Europeans reside in rural areas. Planning and providing end-of-life (EOL) care in rural areas presents some unique challenges. Purpose: In order to understand these challenges, and other important issues or circumstances, a literature search was conducted to assess the state of science on…

  2. Can primary health care staff be trained in basic life-saving surgery?

    African Journals Online (AJOL)

    2012-08-03

    Aug 3, 2012 ... those who can provide basic surgery and anesthesia in order to compensate for .... and essays 1985 – 1990, Epistemology and Learning. Research Group, the Media Lab, Massachusetts Institute of Technology, Ablex Pub.

  3. [Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine].

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Göpfert, M; Gogarten, W; Grosse, J; Heller, A; Heringlake, M; Kastrup, M; Kröner, A; Loer, S; Marggraf, G; Markewitz, A; Reuter, M; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2007-03-01

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).

  4. A theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer.

    Science.gov (United States)

    Landers, Margaret; McCarthy, Geraldine; Savage, Eileen

    2013-08-01

    A paucity of research is available on patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer. Most research undertaken to date on patients' bowel symptoms following surgery for rectal cancer has been largely atheoretical. The purpose of this paper is to describe the process of choosing a theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer. As a result of a thorough literature review, we determined that the Symptom Management Theory provided the most comprehensive framework to guide our research. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn

    Directory of Open Access Journals (Sweden)

    Dora Catré

    2013-12-01

    Full Text Available OBJECTIVE: Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center. METHODS: Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010 in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality. RESULTS: Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams, 28 (6.4% patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132 and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266, compared to those who did not. CONCLUSION: The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population.

  6. Maternal and child health care in an underprivileged area of Bangalore city: Identifying the gaps in the continuum of care

    Directory of Open Access Journals (Sweden)

    Avita R Johnson

    2015-10-01

    Full Text Available Background With over 100 million Indians living in urban slums and high child mortality among low-­‐income groups, focusing on maternal and child health (MCH among urban underprivileged is vital, if India is to achieve the fourth and fifth Millennium Development goals. Objectives To identify the gaps in the MCH Continuum of care, by assessing coverage and quality of Maternal and Child Health Services in an urban underprivileged area of Bangalore City. Methods A survey was conducted in an urban slum of Bangalore City, using systematic random sampling. A total of 178 subjects were interviewed with a pre-­‐tested questionnaire. 88 were mothers who delivered in the last one year (to assess maternal care services, and 90 were mothers of a child aged 12-­‐23 months (to assess immunization coverage. Breastfeeding practices and care during childhood illness were documented in both groups. Results Though institutional delivery rate was 97.7%, only 34.1% mothers had received full antenatal care. The quality of antenatal and postnatal services was poor, practices like prelacteal feeds and delayed initiation of breastfeeding were common. Less than 40 % of children were exclusively breastfed for at least 6 months. Only 53% of children aged 12-­‐23 months were fully immunised. Primary immunisation drop-­‐out rates were high. Mothers’ knowledge regarding vaccines was poor. Children with diarrhea received less fluids and food and only 61% received ORS. Conclusion This study identified the following gaps in the MCH Continuum of Care-­‐ lack of IFA consumption, poor quality of antenatal and postnatal care, high immunisation dropout rates, erroneous breastfeeding practices and inadequate care during diarrhoea. Further research may identify potential solutions to bridging these gaps in MCH care.

  7. Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers

    Directory of Open Access Journals (Sweden)

    Nicholas David

    2010-06-01

    Full Text Available Abstract Background Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1 post-operative AIS patients or surgical candidates (10-18 years (n = 11, (2 their parents (n = 6 and (3 health care providers (n = 11. This paper reports on the findings from focus groups with health care providers. Methods Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. Results Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1 create the website with the target audience in mind; (2 clearly state the purpose of the website and organize website content

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

    Directory of Open Access Journals (Sweden)

    Paulo Ramos David João

    2003-11-01

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

  9. Distribution and sharing of palliative care costs in rural areas of Canada.

    Science.gov (United States)

    Dumont, Serge; Jacobs, Philip; Turcotte, Véronique; Turcotte, Stéphane; Johnston, Grace

    2014-01-01

    Few data are available on the costs occurring during the palliative phase of care and on the sharing of these costs in rural areas. This study aimed to evaluate the costs related to all resources used by rural palliative care patients and to examine how these costs were shared between the public healthcare system (PHCS), patients' families, and not-for-profit organizations (NFPOs). A prospective longitudinal study was undertaken of 82 palliative care patients and their main informal caregivers in rural areas of four Canadian provinces. Telephone interviews were completed at two-week intervals. The mean total cost per patient for a six-month participation in a palliative care program was CA$31,678 +/- 1,160. A large part of this cost was attributable to inpatient hospital stays and was assumed by the PHCS. The patient's family contributed less than a quarter of the mean total cost per patient, and this was mainly attributable to caregiving time.

  10. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Directory of Open Access Journals (Sweden)

    Adilia Maria Pires Sciarra

    2014-03-01

    Full Text Available Introduction: Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective: To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods: The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results: Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion: It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  11. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program--IQIC.

    Science.gov (United States)

    Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando

    2014-01-01

    Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  12. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Science.gov (United States)

    Sciarra, Adilia Maria Pires; Croti, Ulisses Alexandre; Batigalia, Fernando

    2014-01-01

    Introduction Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases. PMID:24896168

  13. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

    Science.gov (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

    2015-10-01

    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

  14. Effects of Clown Doctors on Child and Caregiver Anxiety at the Entrance to the Surgery Care Unit and Separation from Caregivers

    Science.gov (United States)

    Arriaga, Patrícia; Pacheco, Catarina

    2016-01-01

    This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care).…

  15. Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

    Science.gov (United States)

    Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

    2015-11-01

    Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources.

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

    Science.gov (United States)

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

    2013-10-01

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

  17. Analysis of NHSLA claims in orthopedic surgery.

    Science.gov (United States)

    Khan, Irfan H; Jamil, Wiqqas; Lynn, Sam Mathew; Khan, Osman H; Markland, Kate; Giddins, Grey

    2012-05-01

    National Health Service (NHS) statistics in the United Kingdom demonstrate an increase in clinical negligence claims over the past 30 years. Reasons for this include elements of a cultural shift in attitudes toward the medical profession and the growth of the legal services industry. This issue affects medical and surgical health providers worldwide.The authors analyzed 2117 NHS Litigation Authority (NHSLA) orthopedic surgery claims between 1995 and 2001 with respect to these clinical areas: emergency department, outpatient care, surgery (elective or trauma operations), and inpatient care. The authors focused on the costs of settling and defending claims, costs attributable to clinical areas, common causes of claims, and claims relating to elective or trauma surgery. Numbers of claims and legal costs increased most notably in surgery (elective and trauma) and in the emergency department. However, claims are being defended more robustly. The annual cost for a successful defense has remained relatively stable, showing a slight decline. The common causes of claims are postoperative complication; wrong, delayed, or failure of diagnosis; inadequate consent; and wrong-site surgery. Certain surgical specialties (eg, spine and lower-limb surgery) have the most claims made during elective surgery, whereas upper-limb surgery has the most claims made during trauma surgery.The authors recommend that individual trusts liaise with orthopedic surgeons to devise strategies to address areas highlighted in our study. Despite differences in health care systems worldwide, the underlying issues are common. With improved understanding, physicians can deliver the service they promise their patients.

  18. Teleophthalmology: A Model for Eye Care Delivery in Rural and Underserved Areas of India

    Directory of Open Access Journals (Sweden)

    Vijayaraghavan Prathiba

    2011-01-01

    Full Text Available Objectives. To describe the application of teleophthalmology in rural and underserved areas of India. Study Design. This paper describes the major teleophthalmology projects in India and its benefits. Results. Teleophthalmology is the use of telecommunication for electronic transfer of health-related data from rural and underserved areas of India to specialities in urban cities. The MDRF/WDF Rural Diabetes Project has proved to be very beneficial for improvement of quality health care in Tamilnadu and can be replicated at the national level. This community outreach programme using telemedicine facilities has increased awareness of eye diseases, improved access to specialized health care, helped in local community empowerment, and provided employment opportunities. Early detection of sight threatening disorders by teleophthalmology and prompt treatment can help decrease visual impairment. Conclusion. Teleophthalmology can be a very effective model for improving eye care delivery system in rural and underserved areas of India.

  19. Exploring Integration of Care for Children Living with Complex Care Needs Across the European Union and European Economic Area

    Directory of Open Access Journals (Sweden)

    Maria Brenner

    2017-04-01

    Full Text Available Introduction: The aim of this paper is to report on the development of surveys to explore integration of care for children living with complex care needs across the European Union (EU and European Economic Area (EEA.  Theory and methods: Each survey consists of a vignette and questions adapted from the 'Standards for Systems of Care for Children and Youth with Special Health Care Needs and the Eurobarometer Survey'. A Country Agent in each country, a local expert in child health services, will obtain data from indigenous sources.  Results: We identified ‘in-principle’ complex problems and adapted surveys to capture care integration. We expect to get rich data to understand perceptions and to inform actions for a number of complex health issues.  Conclusion: The study has the potential to make a wide contribution to individual countries of the EU/EEA to understand their own integration of services mapped against responses from other member states. Early results are expected in Spring 2017.

  20. Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vonk Noordegraaf Antonie

    2012-02-01

    Full Text Available Abstract Background Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed. Methods/Design We designed a randomized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery, compared to usual clinical care. Two hundred twelve women (18-65 years old undergoing hysterectomy and/or laparoscopic adnexal surgery on benign indication in one of the 7 participating (university hospitals in the Netherlands are expected to take part in this study at baseline. The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery. Secondary outcome measures are the effect of the care program on general recovery, quality of life, pain intensity and complications, and are assessed using questionnaires at baseline, 2, 6, 12 and 26 weeks after surgery. Discussion The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably. Trial registration Netherlands Trial Register (NTR: NTR2087

  1. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    Science.gov (United States)

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  2. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  3. Circuito Quirúrgico Informatizado: Una herramienta para la mejora de la atención al paciente quirúrgico Improving the Care level on a surgery-needed patient through a Computer-Aided Surgery Cares Program

    Directory of Open Access Journals (Sweden)

    Luis Fuentes Cebada

    2007-11-01

    Full Text Available El Programa de Atención al Paciente Quirúrgico en el Hospital Puerta del Mar (Cádiz surge con el objetivo de personalizar la atención y garantizar la continuidad de cuidados y la seguridad de nuestros pacientes en cada una de las unidades por las que va desarrollándose la actividad quirúrgica. Este programa se soporta en una herramienta informática que es el circuito quirúrgico, la cual ha sido diseñada siguiendo la metodología de mejora continua y la participación desde el inicio de los profesionales enfermeros como actores de su desarrollo e implantación. En sólo ocho meses se ha conseguido que más del 55 % de los pacientes intervenidos quirúrgicamente disponga de un registro informatizado en el que se valoran, diagnostican, planifican y abordan los aspectos relacionados con la propia intervención quirúrgica como una parte añadida a las respuestas humanas que la misma ocasiona tanto a él como a su familia. Todo ello haciendo uso de las taxonomías enfermeras NANDA, NOC y NIC, con un enfoque holístico, centrado en la persona como agente y receptor de cuidados. Acompaña a este registro un sistema de información desde el que se explotan aspectos tales como la prevalencia diagnóstica enfermera, intervenciones realizadas, alergias, profilaxis antibiótica administrada, etc.The Surgery-needed Care Program, currently under test at the Puerta del Mar Hospital in Cadiz, has been conceived with the aim of both tuning the care level to each individual patient and, at the same time, to secure a continuous assistance through all the units involved in the surgery process. It is based on a computer tool so called Surgery Program. This computer application has been designed on the basis of continually-improving approach while counting with the enrolment, from the very first phases, of nurses in the affected units both in development and set-up steps. After just eight months running this Program, we have been able to create a digital

  4. 42 CFR Appendix D to Part 5 - Criteria for Designation of Areas Having Shortages of Vision Care Professional(s)

    Science.gov (United States)

    2010-10-01

    ... of Vision Care Professional(s) D Appendix D to Part 5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... Pt. 5, App. D Appendix D to Part 5—Criteria for Designation of Areas Having Shortages of Vision Care... of vision care professional(s) if the following three criteria are met: 1. The area is a...

  5. The effect of critical care nursing and organizational characteristics on pediatric cardiac surgery mortality in the United States.

    Science.gov (United States)

    Hickey, Patricia A; Gauvreau, Kimberlee; Curley, Martha A Q; Connor, Jean A

    2014-10-01

    This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States. Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality. Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years. The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality. These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality.

  6. Urologic complications following obstetrics and gynecologicai surgery: Our experience in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilip Kumar Pal

    2016-01-01

    Conclusion: Although obstetrical causes are still important in developing countries, gynecological procedures especially laparoscopic surgeries are on the rise. In these procedures the suspicion of urological injuries should be kept in mind and intra-operative detection and early repair should be attempted. Delayed diagnosis and improper treatment leads to severe complications.

  7. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  8. Low level of stroke care awareness among stroke patients’ caregivers: an important but neglected area of stroke care

    Directory of Open Access Journals (Sweden)

    N Sharma

    2014-04-01

    Full Text Available Objective Stroke is one of the leading causes of mortality and morbidity worldwide. Stroke patients require longterm care for better outcome. Most often family members are the back bone of the service provided to people affected by stroke. Stroke patients and their caregivers are known to have large gaps in stroke knowledge and have suboptimal personal health behaviors, thereby putting the patient at high risk for complications. Our study was designed to explore the stroke care awareness among stroke patients' caregivers. Methods 50 stroke caregivers aged >18 years from neurology ward of College of Medical Sciences-Teaching Hospital were selected by non-probability purposive sampling from June 2012 to July 2012. Questionnaire focusing basic stroke care was prepared by researchers with the help of literature and a neurophysician. Validity and reliability of the tools were tested and data collected. Analysis of collected data was done using SPSS 16.0. Results The mean age of the respondents was 40 years (range: 20-80 years. Thirty-nine (78% were either spouse or children. Thirty-eight (76% caregivers were literate. Overall, 27 (54% caregivers had low level of awareness regarding stroke care and mean knowledge score was 23.7. Conclusion This study has revealed the existence of low level of stroke care awareness amongst stroke caregivers. Interventional education program oriented to address this important yet neglected area can improve the stroke care in countries like Nepal where recent advancement for stroke management is lacking.   Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10208    

  9. Incidence of and Risk Factors for Delirium After Cardiac Surgery at a Quaternary Care Center: A Retrospective Cohort Study.

    Science.gov (United States)

    Tse, Lurdes; Schwarz, Stephan K W; Bowering, John B; Moore, Randell L; Barr, Alasdair M

    2015-12-01

    Delirium after cardiac surgery is associated with persistent cognitive deficits and increased mortality. The authors' objective was to determine the incidence of and risk factors for delirium in a mixed cohort of patients undergoing on-pump and off-pump cardiac surgery and transcatheter aortic valve implantations (TAVI) in a Canadian quaternary care center. This study followed a pilot from the same center on patients treated in 2007. A retrospective cohort study. A quaternary care center in Vancouver, B.C., Canada. Patients undergoing cardiopulmonary bypass grafts (CABG), conventional valve replacements, combined CABG-valve replacements, transfemoral TAVI, or transapical TAVI in 2008. Data from 679 charts on demographics, medical history, medications, laboratory results, surgical procedure, and anesthesia were abstracted and analyzed using univariate and multivariate analyses. Nurses screened for delirium using the Confusion Assessment Method, and the final diagnoses were made clinically by physicians. Risk factors were identified using logistic regression and bootstrapping. Delirium occurred in 28% of patients. Delirium was most common in transapical TAVI (47%), and least common in transfemoral TAVI (17%). Delirious patients were older and had greater preoperative cardiac and neurologic burdens than nondelirious patients. Age≥64 years, history of delirium, history of stroke/transient ischemic attack, cognitive impairment, depression, and preoperative use of beta-blocker(s) were associated independently with delirium. The incidence of delirium varied greatly with the type of procedure. The authors' logistic regression model showed that age and certain pre-existing neurologic conditions could predict delirium after cardiac surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.

  11. Supportive nursing care around breast cancer surgery : An evaluation of the 1997 status in The Netherlands

    NARCIS (Netherlands)

    Thijs-Boer, FM; de Kruif, ATC; van de Wiel, HBM

    1999-01-01

    This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals th

  12. Supportive nursing care around breast cancer surgery : An evaluation of the 1997 status in The Netherlands

    NARCIS (Netherlands)

    Thijs-Boer, FM; de Kruif, ATC; van de Wiel, HBM

    This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals

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

    Directory of Open Access Journals (Sweden)

    Tejaswini Arunachala Murthy

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  15. The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act.

    Science.gov (United States)

    Wiznia, Daniel H; Nwachuku, Emmanuel; Roth, Alexander; Kim, Chang-Yeon; Save, Ameya; Anandasivam, Nidharshan S; Medvecky, Michael; Pelker, Richard

    2017-07-01

    The goal of the Patient Protection and Affordable Care Act (PPACA) was to expand patient access to health care. Since the rollout of the PPACA, Medicaid patients have demonstrated difficulty obtaining appointments in some specialty care settings. To assess the effect of insurance type (Medicaid and private) on patient access to orthopaedic surgery sports medicine specialists for a semiurgent evaluation of a likely operative bucket-handle meniscus tear. The study was designed to determine whether disparities in access exist since the PPACA rollout. Cohort study; Level of evidence, 2. The design was to call 180 orthopaedic surgery sports medicine specialists in 6 representative states (California, Ohio, New York, Florida, Texas, and North Carolina) between June 2015 and December 2015. An appointment was requested for the caller's fictitious 25-year-old-brother who had suffered a bucket-handle meniscus tear. Each office was called twice to assess the ease of obtaining an appointment: once for patients with Medicaid and once for patients with private insurance. For each call, data pertaining to whether an appointment was given, wait times, and barriers to receiving an appointment were recorded. A total of 177 surgeons were called within the study period. Overall, 27.1% of offices scheduled an appointment for a patient with Medicaid, compared with 91.2% (P < .0001) for a patient with private insurance. Medicaid patients were significantly more likely to be denied an appointment due to lack of referral compared with private patients (40.2% vs 3.7%, P < .0001), and Medicaid patients were more likely to experience longer wait times for an appointment (15 vs 12 days, P < .029). No significant differences were found in patients' access to orthopaedic surgery sports medicine specialists between Medicaid-expanded and -nonexpanded states. Medicaid reimbursement for knee arthroscopy with meniscus repair was not significantly correlated with appointment success rate or patient

  16. Bloodless medicine and surgery in the OR and beyond.

    Science.gov (United States)

    Cogliano, Janet; Kisner, Debbie

    2002-11-01

    Ideas about bloodless surgery are changing. It now is more than transfusion-free surgery for Jehovah's Witnesses. Technological advances and concerns about the safety and availability of blood have led to interest in bloodless surgery among non-Witnesses. Perioperative nurses need to be aware of bloodless surgery technology, which typically incorporates the use of recombinant human erythropoietin and special surgical techniques and equipment. They must have a proper attitude toward blood conservation and respect patient autonomy. Bloodless surgery care extends across specialties and inpatient areas. A knowledge of bloodless surgery will facilitate clear communication between staff members, patients, and patients' family members.

  17. Structure of Primary Health Care: Lessons from a Rural Area in ...

    African Journals Online (AJOL)

    It is assumed that given the proper structure, quality medical care will follow. ... In addition 44.4% lacked basic equipment and none had a maintenance plan. ... of PHC Ikosi-Ejinrin LCDA, a rural area in south-west Nigeria, is inadequate.

  18. Sustaining hope and life courage in patients undergoing ovarian cancer surgery - the impact of care

    DEFF Research Database (Denmark)

    Seibaek, L; Delmar, C; Hounsgaard, L

    2017-01-01

    Ovarian cancer is the leading cause of death from a gynaecological malignancy in the Western World. To explore if experiences of physical comfort influenced hope and life courage during final diagnosis and early treatment, qualitative research interviews were performed with women undergoing surgery......, and it was a main finding that sufficient symptom management combined with sensitive attention of the patient sustained her hope, life courage and action competences. Surgery constitutes an essential part of sufficient cancer treatment. However, the diagnostic and pre-operative phase represents an insufficiently...... for ovarian cancer. By applying a phenomenological-hermeneutic methodology, the findings were systematically identified, put into meaning-structures, interpreted and critically discussed. The empirical material constituted a main theme concerning "Hope and life courage are created in the interplay between...

  19. Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery.

    Science.gov (United States)

    van Diepen, Sean; Merrill, Peter D; Carrier, Michel; Tardif, Jean-Claude; Podgoreanu, Mihai; Alexander, John H; Lopes, Renato D

    2017-05-01

    Myonecrosis after coronary artery bypass graft (CABG) surgery is associated with excess mortality. Tranexamic acid (TA), an anti-fibrinolytic agent, has been shown to reduce peri-operative blood loss without increasing the risk of myocardial infarction (MI); however, no large study has examined the association between TA treatment and post-CABG myonecrosis. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II trial, inverse probability weighting of the propensity to receive TA was used to test for differences among the 656 patients receiving and 770 patients not receiving TA. The primary outcome was creatine kinase MB (CK-MB) area under the curve (AUC) through 24 h. The secondary outcome was 30-day cardiovascular death or MI. Patients who received TA were more frequently female, had a previous MI, heart failure, low molecular weight heparin therapy, on-pump CABG, valvular surgery, and saphenous vein or radial grafts. The median 24-h CK-MB AUC was higher in TA-treated patients [301.9 (IQR 196.7-495.6) vs 253.5 (153.4-432.5) ng h/mL, p < 0.001]. No differences in the 30-day incidence of cardiovascular death or MI were observed (8.7 vs 8.3%, adjusted OR 0.99; 95% CI 0.67-1.45, p = 0.948). In patients undergoing CABG, TA use was associated with a higher risk of myonecrosis; however, no differences were observed in death or MI. Future larger studies should be directed at examining the pathophysiology of TA myonecrosis, and its association with subsequent clinical outcomes.

  20. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  1. The use of stereophotogrammetry in oral surgery: measurement of area changes after secondary epithelization and grafting vestibuloplasties.

    Science.gov (United States)

    Ozturk, Adnan; Dolanmaz, Dogan; Celik, Salih; Isik, Kubilay; Karabork, Hakan; Yildiz, Ferruh; Yakar, Murat

    2012-01-01

    Stereophotogrammetry (SPT) is a method in which three-dimensional coordinates are calculated from multiple two-dimensional projections. The purpose of this study was to compare the surface area changes between the secondary healing and grafting vestibuloplasty techniques in the mandible by using a stereophotogrammetric technique (SPT). Thirteen patients were included in this study: six patients were managed by using full-thickness skin or palatal mucosa grafts (two full-thickness palatal mucosal grafts and four full-thickness skin grafts); the remaining seven patients, who did not accept a second surgery for graft harvesting, underwent secondary epithelization vestibuloplasties. Postoperative changes of surgical areas were measured by using SPT. The Wilcoxon (intragroup comparisons) and Mann-Whitney U (intergroup comparisons) tests were used for analysis of data. In the grafting vestibuloplasty group, the surface area gain was statistically significant (P vestibuloplasty group, there was no significant difference (P > 0.05), with even decrease of surface area being noted in some cases. SPT is a valid method for measurement of intraoral soft tissue changes.

  2. Does stimulating self-care increase self-care behaviour for minor illnesses of Dutch and Turkish inhabitants of a deprived area in The Netherlands?

    NARCIS (Netherlands)

    Plass, A.M.C.; Timmermans, D.R.M.; Wal, G. van der

    2006-01-01

    OBJECTIVE: The aim of the present study was to examine whether self-care behaviour increases after a self-care stimulating intervention that proved to be successful in reducing care-seeking behaviour for minor illnesses of Turkish and Dutch inhabitants of a deprived area in the Netherlands, and to s

  3. Ambulance Dispatches From Unaffected Areas After the Great East Japan Earthquake: Impact on Emergency Care in the Unaffected Areas.

    Science.gov (United States)

    Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Abe, Takeru; Hasegawa, Manabu; Nabeshima, Yoshihiro

    2015-12-01

    Although dispatching ambulance crews from unaffected areas to a disaster zone is inevitable when a major disaster occurs, the effect on emergency care in the unaffected areas has not been studied. We evaluated whether dispatching ambulance crews from unaffected prefectures to those damaged by the Great East Japan Earthquake was associated with reduced resuscitation outcomes in out-of-hospital cardiac arrest (OHCA) cases in the unaffected areas. We used the Box-Jenkins transfer function model to assess the relationship between ambulance crew dispatches and return of spontaneous circulation (ROSC) before hospital arrival or 1-month survival after the cardiac event. In a model whose output was the rate of ROSC before hospital arrival, dispatching 1000 ambulance crews was associated with a 0.474% decrease in the rate of ROSC after the dispatch in the prefectures (p=0.023). In a model whose output was the rate of 1-month survival, dispatching 1000 ambulance crews was associated with a 0.502% decrease in the rate of 1-month survival after the dispatch in the prefectures (p=0.011). The dispatch of ambulances from unaffected prefectures to earthquake-stricken areas was associated with a subsequent decrease in the ROSC and 1-month survival rates in OHCA cases in the unaffected prefectures.

  4. Determining health-care facility catchment areas in Uganda using data on malaria-related visits.

    Science.gov (United States)

    Zinszer, Kate; Charland, Katia; Kigozi, Ruth; Dorsey, Grant; Kamya, Moses R; Buckeridge, David L

    2014-03-01

    To illustrate the use of a new method for defining the catchment areas of health-care facilities based on their utilization. The catchment areas of six health-care facilities in Uganda were determined using the cumulative case ratio: the ratio of the observed to expected utilization of a facility for a particular condition by patients from small administrative areas. The cumulative case ratio for malaria-related visits to these facilities was determined using data from the Uganda Malaria Surveillance Project. Catchment areas were also derived using various straight line and road network distances from the facility. Subsequently, the 1-year cumulative malaria case rate was calculated for each catchment area, as determined using the three methods. The 1-year cumulative malaria case rate varied considerably with the method used to define the catchment areas. With the cumulative case ratio approach, the catchment area could include noncontiguous areas. With the distance approaches, the denominator increased substantially with distance, whereas the numerator increased only slightly. The largest cumulative case rate per 1000 population was for the Kamwezi facility: 234.9 (95% confidence interval, CI: 226.2-243.8) for a straight-line distance of 5 km, 193.1 (95% CI: 186.8-199.6) for the cumulative case ratio approach and 156.1 (95% CI: 150.9-161.4) for a road network distance of 5 km. Use of the cumulative case ratio for malaria-related visits to determine health-care facility catchment areas was feasible. Moreover, this approach took into account patients' actual addresses, whereas using distance from the facility did not.

  5. From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability.

    Science.gov (United States)

    Cook, David; Thompson, Jeffrey E; Habermann, Elizabeth B; Visscher, Sue L; Dearani, Joseph A; Roger, Veronique L; Borah, Bijan J

    2014-05-01

    The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs.

  6. Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

    Directory of Open Access Journals (Sweden)

    Congdon Peter

    2006-11-01

    Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In

  7. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

    Directory of Open Access Journals (Sweden)

    Mathoulin-Pélissier Simone

    2012-07-01

    Full Text Available Abstract Background Colorectal cancer (CRC care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery, and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN, non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68% with colon and 381 (32% with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location; whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care

  8. Computerized prediction of intensive care unit discharge after cardiac surgery: development and validation of a Gaussian processes model.

    Science.gov (United States)

    Meyfroidt, Geert; Güiza, Fabian; Cottem, Dominiek; De Becker, Wilfried; Van Loon, Kristien; Aerts, Jean-Marie; Berckmans, Daniël; Ramon, Jan; Bruynooghe, Maurice; Van den Berghe, Greet

    2011-10-25

    The intensive care unit (ICU) length of stay (LOS) of patients undergoing cardiac surgery may vary considerably, and is often difficult to predict within the first hours after admission. The early clinical evolution of a cardiac surgery patient might be predictive for his LOS. The purpose of the present study was to develop a predictive model for ICU discharge after non-emergency cardiac surgery, by analyzing the first 4 hours of data in the computerized medical record of these patients with Gaussian processes (GP), a machine learning technique. Non-interventional study. Predictive modeling, separate development (n = 461) and validation (n = 499) cohort. GP models were developed to predict the probability of ICU discharge the day after surgery (classification task), and to predict the day of ICU discharge as a discrete variable (regression task). GP predictions were compared with predictions by EuroSCORE, nurses and physicians. The classification task was evaluated using aROC for discrimination, and Brier Score, Brier Score Scaled, and Hosmer-Lemeshow test for calibration. The regression task was evaluated by comparing median actual and predicted discharge, loss penalty function (LPF) ((actual-predicted)/actual) and calculating root mean squared relative errors (RMSRE). Median (P25-P75) ICU length of stay was 3 (2-5) days. For classification, the GP model showed an aROC of 0.758 which was significantly higher than the predictions by nurses, but not better than EuroSCORE and physicians. The GP had the best calibration, with a Brier Score of 0.179 and Hosmer-Lemeshow p-value of 0.382. For regression, GP had the highest proportion of patients with a correctly predicted day of discharge (40%), which was significantly better than the EuroSCORE (p nurses (p = 0.044) but equivalent to physicians. GP had the lowest RMSRE (0.408) of all predictive models. A GP model that uses PDMS data of the first 4 hours after admission in the ICU of scheduled adult cardiac surgery

  9. Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care

    Directory of Open Access Journals (Sweden)

    Markus Lehner

    2017-01-01

    Full Text Available Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management. Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM. Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings. Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance.

  10. Two rare cases of Acremonium acute endophthalmitis after cataract surgery in a tertiary care hospital.

    Science.gov (United States)

    Calderaro, Adriana; Motta, Federica; Larini, Sandra; Gorrini, Chiara; Martinelli, Monica; Piscopo, Giovanni; Benecchi, Magda; Arcangeletti, Maria Cristina; Medici, Maria Cristina; De Conto, Flora; Montecchini, Sara; Neri, Alberto; Scaroni, Patrizia; Gandolfi, Stefano; Chezzi, Carlo

    2013-10-01

    This report describes two cases of Acremonium sp. endophthalmitis, occurring in two patients who underwent cataract surgery on the same day in the same operating room of our hospital ophthalmology clinic. Diagnosis of fungal endophthalmitis was established by the repeated isolation of the same fungal agent from vitreous washing, acqueous fluid and intraocular lens samples and by its identification on the basis of morphological and molecular features. The cases reported in this study emphasize the need for clinical microbiology laboratories to be prepared to face the diagnosis of uncommon infectious diseases such as exogenous fungal endophthalmitis by Acremonium, and to enhance the awareness of surgeons and clinicians of this occurrence.

  11. Profile of acute kidney injury after open heart surgeries in a tertiary care hospital.

    Science.gov (United States)

    Rather, Fayaz A; Najar, Saleem M; Malla, Hilal A; Ahangar, A G; Bhat, Hilal M; Wani, Imtiyaz A

    2015-11-01

    Our objective is to determine the incidence, etiology, risk factors and outcome of acute kidney injury (AKI) after open heart surgery. A prospective study was conducted on 62 patients who underwent open heart surgery and were followed-up for the development of AKI and to determine its incidence, etiology and outcome. Post-operative AKI was considered when the post-operative serum creatinine was >1.5 mg/dL or there was doubling of serum creatinine above the baseline (pre-operative) with a prior normal renal function. The incidence of AKI in the post-operative period in our study was 17.7%. The common etiological factors for AKI in our study were sepsis, hypotension, prolonged need for ventilator and inotropic support and drugs given in the post-operative period. The important risk factors for the development of AKI in the post-operative period were hypertension, diabetes mellitus, gout, prolonged total bypass time and prolonged aortic cross-clamp time. The overall mortality in our study subjects was 11.3% (seven of 62 died) and the mortality in the patients who developed post-operative AKI was 71.4%.

  12. Developing pediatric surgery in low- and middle-income countries: An evaluation of contemporary education and care delivery models.

    Science.gov (United States)

    Butler, Marilyn W

    2016-02-01

    There are several different models of education and care delivery models in low- and middle-income countries (LMICs), and many endeavors combine more than one of the described models. This article summarizes the burden of pediatric surgical disease and discusses the benefits and shortcomings of the following: faith-based missions; short-term surgical trips; partnerships, twinning, and academic collaborations; teaching workshops, "train the trainer," and pediatric surgery camps; specialty treatment centers; online conferences, telemedicine, and mobile health; specific programs for exchange and education; and training in high-income countries (HICs), fellowships, and observorships. It then addresses ethical concerns common to all humanitarian pediatric surgical efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Patients' satisfaction and spectacle independence after cataract surgery with multifocal intraocular lens implantation in a tertiary care hospital.

    Science.gov (United States)

    Baig, Rashid; A Chaudhry, Tanveer; Kukreja, Saajan; Shakil, Sidra; Ahmad, Khabir

    2016-06-01

    This single group cohort study, undertaken at Aga Khan University Hospital, Karachi, from Jan 2012 to September 2013, assessed patients' satisfaction, spectacle independence and visual disturbance after implantation of multifocal IOLs. A total of 39 patients who underwent bilateral cataract surgery with multifocal IOL implantation were included for telephonic interviews. The mean age of participants was 55.5 ± 8.1 years. The mean follow up time was 9.60 ± 3.19 months. The overall satisfaction rate after surgery was found to be 84.6% and there was no statistically significant association of satisfaction with gender, age or education. In all 84.6%, 94.9% and 84.6% people had spectacle independence for far, intermediate and near, respectively. More than half of participants (59%) had some degree of visual disturbance. In this study, multifocal IOL implantation provided high levels of satisfaction and spectacle independence despite notable risk of halo or glare symptoms at night. Therefore, careful patient selection and preoperative counselling regarding possible risks and benefits is recommended.

  14. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Directory of Open Access Journals (Sweden)

    Anis Dizdarevic

    2016-01-01

    Full Text Available Objective. Primary lateral sclerosis (PLS is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS. Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use.

  15. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Science.gov (United States)

    Fernandes, Anthony

    2016-01-01

    Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use. PMID:27200193

  16. Development and implementation of a clinical pathway for cardiac surgery in the intensive care unit: Effects on protocol adherence.

    Science.gov (United States)

    van der Kolk, Marion; van den Boogaard, Mark; Ter Brugge-Speelman, Corine; Hol, Jeroen; Noyez, Luc; van Laarhoven, Kees; van der Hoeven, Hans; Pickkers, Peter

    2017-07-18

    Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients. This is a pre-post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU-nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report. A tailored implementation strategy was used. Primary outcome measure was protocol adherence above 80% on the domains of blood pressure control, action on chest tube blood loss and electrolyte control within the CP. In a 4-month period, 84 consecutive CP patients were included and compared with 162 matched control patients admitted in the year before implementation; 3 patients were excluded. Propensity score was used as matching parameter. CP patients were more likely to receive early adequate treatment for derangements in electrolytes (96% vs 47%, P cardiac surgical patients. Implementation of a CP and the use of a special variance report could be a blueprint for the implementation and use of a CP in low-volume high complex surgery. © 2017 John Wiley & Sons, Ltd.

  17. Are you a Canadian thinking about going abroad for surgery or other medical care?

    OpenAIRE

    SFU Medical Tourism Research Group

    2012-01-01

    Are you considering going abroad for medical care? The Simon Fraser University Medical Tourism Research Group has developed the following guide to help inform your decision. This information sheet was developed in consultation with health workers, medical tourism professionals, and researchers in order to help you consider the pros and cons of engaging in medical tourism.

  18. Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills?

    NARCIS (Netherlands)

    Rijsingen, M.C.J. van; Vossen, R.; Huystee, B.E.W.L. van; Gorgels, W.J.; Gerritsen, M.J.P.

    2015-01-01

    BACKGROUND: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. OBJECTIVES: To assess surgical procedures used by GPs in skin tumour management. METHODS: We performed a retrospective study of 1,898

  19. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system

    Science.gov (United States)

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-01-01

    BACKGROUND: The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. OBJECTIVE: The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. METHODS: The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. RESULTS: The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. CONCLUSIONS: Despite the minimal use of OPCAB in Canada’s public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators’ real-world experience. The results OPCAB were at least equivalent to those of ONCAB. PMID:17380221

  20. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies

    Science.gov (United States)

    Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.

    2010-03-01

    BackgroundMultiple nations are actively pursuing manned exploration of space beyond low-earth orbit. The responsibility to improve surgical care for spaceflight is substantial. Although the use of parabolic flight as a terrestrial analogue to study surgery in weightlessness (0 g) is well described, minimal data is available to guide the appropriate delivery of anesthesia. After studying anesthetized pigs in a 0 g parabolic flight environment, our group developed a comprehensive protocol describing prolonged anesthesia in a parabolic flight analogue space surgery study (PFASSS). Novel challenges included a physically remote vivarium, prolonged (>10 h) anesthetic requirements, and the provision of veterinary operating room/intensive care unit (ICU) equivalency on-board an aircraft with physical dimensions of ethical approval, multiple ground laboratory sessions were conducted with combinations of anesthetic, pre-medication, and induction protocols on Yorkshire-cross specific pathogen-free (SPF) pigs. Several constant rate infusion (CRI) intravenous anesthetic combinations were tested. In each regimen, opioids were administered to ensure analgesia. Ventilation was supported mechanically with blended gradients of oxygen. The best performing terrestrial 1 g regime was flight tested in parabolic flight for its effectiveness in sustaining optimal and prolonged anesthesia, analgesia, and maintaining hemodynamic stability. Each flight day, a fully anesthetized, ventilated, and surgically instrumented pig was transported to the Flight Research Laboratory (FRL) in a temperature-controlled animal ambulance. A modular on-board surgical/ICU suite with appropriate anesthesia/ICU and surgical support capabilities was employed. ResultsThe mean duration of anesthesia (per flight day) was 10.28 h over four consecutive days. A barbiturate and ketamine-based CRI anesthetic regimen supplemented with narcotic analgesia by bolus administration offered the greatest prolonged hemodynamic

  1. Spontaneous speech of patients with gliomas in eloquent areas before and early after surgery.

    Science.gov (United States)

    Satoer, Djaina; Vincent, Arnaud; Smits, Marion; Dirven, Clemens; Visch-Brink, Evy

    2013-04-01

    Glioma patients often complain about problems in daily conversation. A detailed spontaneous speech analysis could provide more insight in these communicative problems; no previous studies are reported. To select sensitive parameters in spontaneous speech pre- and post-operatively in patients with gliomas in eloquent areas. We included 27 patients and 21 healthy controls. In addition to a naming and category fluency test, spontaneous speech was collected 1 month pre-operatively and 3 months post-operatively, and analysed with the variables: Self-corrections, Repetitions, Lexical Diversity, Incomplete Sentences and Mean Length of Utterance (MLUw). A correlation analysis was performed between the linguistic variables and tumour characteristics (grade, localisation and volume), treatment related factors, and between the linguistic variables and the language tasks. Pre-operatively, patients produced more Incomplete Sentences than the controls (p speech was influenced by tumour grade and localisation. There was no influence of tumour volume or treatment-related factors. Pre- and post-operatively, patients' performance on the naming and the fluency task deviated from normal (p speech, partly influenced by tumour characteristics. A spontaneous speech analysis appeared to be a valuable addition to standardised language tasks. Both measurements are important tools to obtain a complete linguistic profile.

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

    Science.gov (United States)

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

    2014-01-01

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

  3. STN area detection using K-NN classifiers for MER recordings in Parkinson patients during neurostimulator implant surgery

    Science.gov (United States)

    Schiaffino, L.; Rosado Muñoz, A.; Guerrero Martínez, J.; Francés Villora, J.; Gutiérrez, A.; Martínez Torres, I.; Kohan, y. D. R.

    2016-04-01

    Deep Brain Stimulation (DBS) applies electric pulses into the subthalamic nucleus (STN) improving tremor and other symptoms associated to Parkinson’s disease. Accurate STN detection for proper location and implant of the stimulating electrodes is a complex task and surgeons are not always certain about final location. Signals from the STN acquired during DBS surgery are obtained with microelectrodes, having specific characteristics differing from other brain areas. Using supervised learning, a trained model based on previous microelectrode recordings (MER) can be obtained, being able to successfully classify the STN area for new MER signals. The K Nearest Neighbours (K-NN) algorithm has been successfully applied to STN detection. However, the use of the fuzzy form of the K-NN algorithm (KNN-F) has not been reported. This work compares the STN detection algorithm of K-NN and KNN-F. Real MER recordings from eight patients where previously classified by neurophysiologists, defining 15 features. Sensitivity and specificity for the classifiers are obtained, Wilcoxon signed rank non-parametric test is used as statistical hypothesis validation. We conclude that the performance of KNN-F classifier is higher than K-NN with p<0.01 in STN specificity.

  4. Does ICU structure impact patient outcomes after congenital heart surgery? A critical appraisal of "care models and associated outcomes in congenital heart surgery" by Burstein et al (Pediatrics 2011; 127: e1482-e1489).

    Science.gov (United States)

    Hilvers, Pamela S; Thammasitboon, Satid

    2014-01-01

    To review the findings and discuss the implications of different ICU care models on morbidity and mortality in pediatric patients after congenital heart surgery. The electronic PubMed database was used to perform the clinical query, as well as to search for additional pertinent literature. The article by Burstein DS et al "Care Models and Associated Outcomes in Congenital Heart Surgery. Pediatrics 2011; 15:77-81" was selected for critical appraisal and literature review. The authors evaluated in-hospital mortality, postoperative length of stay, and postoperative complications in pediatric patients after congenital heart surgery and compared the odds of these outcomes by model of care received (cardiac ICU or mixed ICU). The data for the study was extracted from the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) database. Overall, the cardiac ICU group represented hospitals with higher surgical volumes and included more patients with high-risk defects. After multivariate analysis, the adjusted in-hospital mortality was not associated with the care model (cardiac ICU vs. ICU). The only significant finding was a lower morality in the STS-EACTS risk category 3 (odds ratio, 0.47 [95% CI, 0.25-0.86]). There were no significant differences between groups for adjusted postoperative length of stay or postoperative complications. This paper suggests that the composition of the ICU is not a critical factor in determining outcomes after congenital heart surgery. Other factors, such as expertise of the nurses, physicians, and surgeons, as well as technical performance, should be considered.

  5. Effects of Clown Doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

    OpenAIRE

    Patrícia Arriaga; Catarina Pacheco

    2016-01-01

    This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiet...

  6. How much and what type: analysis of the first year of the acute care surgery operative case log.

    Science.gov (United States)

    Dente, Christopher J; Duane, Therese M; Jurkovich, Gregory J; Britt, L D; Meredith, J Wayne; Fildes, John J

    2014-02-01

    A case log was created by the American Association for the Surgery of Trauma Acute Care Surgery (ACS) committee to track trainee operative experiences, allowing them to enter their cases in the form of Current Procedural Terminology (CPT) codes. We hypothesized that the number of cases an ACS trainee performed would be similar to the expectations of a fifth-year general surgery resident and that the current list of essential and desired cases (E/D list) would accurately reflect cases done by ACS trainees. The database was queried from July 1, 2011, to June 30, 2012. Trainees were classified as those in American Association for the Surgery of Trauma-accredited fellowships (ACC) and those in ACS fellowships not accredited (non-ACC). CPT codes were mapped to the E/D list. Cases entered manually were individually reviewed and assigned a CPT code if possible or listed as "noncodable." To compensate for nonoperative rotations and noncompliance, case numbers were analyzed both annually and monthly to estimate average case numbers for all trainees. In addition, case logs of trainees were compared with the E/D list to assess how well it reflected actual trainee experience. Eighteen ACC ACS and 11 non-ACC ACS trainees performed 16.4 (12.6) cases per month compared with 15.7 (14.2) cases for non-ACC ACS fellows (p = 0.71). When annualized, trainees performed, on average, 195 cases per year. Annual analysis led to similar results. The E/D list captured only approximately 50% of the trainees' operative experience. Only 77 cases were categorized as pediatric. ACS trainees have substantial operative experience averaging nearly 200 major cases during their ACS year. However, high variability exists in the number of essential or desirable cases being performed with approximately 50% of the fellows' operative experience falling outside the E/D list of cases. Modification of the fellows' operative experience and/or the rotation requirements seems to be needed to provide experience in

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

    Science.gov (United States)

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

    2017-02-10

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

  8. Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area.

    Science.gov (United States)

    Dalsgaard Jensen, Trine; Penninga, Luit

    2016-05-18

    Appendicitis during pregnancy causes severe diagnostic problems, and is associated with an increase in perforation rate and morbidity compared to that in the normal population. In addition, it may cause preterm birth and fetal loss. In remote areas, appendicitis during pregnancy, besides presenting diagnostic problems, also creates treatment difficulties. In Northern Greenland, geographical distances are vast, and weather conditions can be extreme. We report a case of a Greenlandic Inuit woman who presented with appendicitis during pregnancy. The nearest hospital with surgical and anaesthetic care was located nearly 1200 km away, and, due to extreme weather conditions, she could not be transferred immediately. She was treated with intravenous antibiotic treatment, and after weather conditions had improved, she was transferred by aeroplane and underwent appendicectomy. She recovered without complications. Our case suggests that appendicitis during pregnancy may be treated with antibiotics in remote areas until surgical treatment is available.

  9. Undocumented immigration status and diabetes care among Mexican immigrants in two immigration "sanctuary" areas.

    Science.gov (United States)

    Iten, A Elizabeth; Jacobs, Elizabeth A; Lahiff, Maureen; Fernández, Alicia

    2014-04-01

    The objective of this study is to investigate the relationship between immigration status and the patient experience of health care, diabetes self-management, and clinical outcomes among Mexican immigrants with diabetes receiving health care in two immigration sanctuary cities. We used data from the Immigration, Culture and Health Care study, a cross-sectional survey and medical record study of low-income patients with diabetes recruited from public hospitals and community clinics in the San Francisco Bay Area and Chicago. Undocumented Mexican, documented Mexican immigrants, and US-born Mexican-Americans' health care experiences, diabetes self-management, and clinical outcomes were compared using multivariate linear and logistic regressions. We found no significant differences in reports of physician communication, or in measures of diabetes management between undocumented and documented immigrants. All three groups had similar clinical outcomes in glycemic, systolic blood pressure, and lipid control. These results indicate that, at least in some settings, undocumented Mexican immigrants with diabetes can achieve similar clinical outcomes and report similar health care experiences as documented immigrants and US-born Mexican-Americans.

  10. The prevalence, aetiology and management of wounds in a community care area in Ireland.

    LENUS (Irish Health Repository)

    Skerritt, Louise

    2014-06-01

    This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.

  11. Assessment of Pharmacists' Perception of Patient Care Competence and Need for Training in Rural and Urban Areas in North Dakota

    Science.gov (United States)

    Scott, David M.

    2010-01-01

    Context: Few studies have examined pharmacists' level of patient care competence and need for continuous professional development in rural areas. Purpose: To assess North Dakota pharmacists' practice setting, perceived level of patient care competencies, and the need for professional development in urban and rural areas. Methods: A survey was…

  12. Teamwork in skull base surgery: An avenue for improvement in patient care

    Science.gov (United States)

    McLaughlin, Nancy; Carrau, Ricardo L.; Kelly, Daniel F.; Prevedello, Daniel M.; Kassam, Amin B.

    2013-01-01

    Background: During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Methods: Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: “teamwork”, “multidisciplinary”, “interdisciplinary”, “surgery”, “skull base”, “neurosurgery”, “tumor”, and “outcome”. Results: Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support. Conclusions: Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise. PMID:23607058

  13. Patient care is a collective responsibility: perceptions of professional responsibility in surgery.

    Science.gov (United States)

    Park, Jason; Woodrow, Sarah I; Reznick, Richard K; Beales, Jennifer; MacRae, Helen M

    2007-07-01

    Changes in training are likely to affect the professionalization process, but such complex social phenomena are poorly studied by quantitative research methodologies. In contrast, qualitative research designs are more effective in exploring complex social processes. The objective of this study was to use a qualitative methodology to explore how professional responsibilities are perceived by surgical trainees and faculty in the current academic environment. Semi-structured individual interviews of 43 surgical residents and faculty (ranging from second year residents to senior faculty) were conducted at 2 academic institutions. The interviews consisted of open-ended questions, followed by discussion of 4 written, case-based scenarios on specific issues related to professional responsibilities. All interviews were audio-recorded and transcribed, and then analyzed for emergent themes by 3 researchers using a grounded theory approach. In discussing professional responsibilities, the motivations that shaped participants' responses reflected a balance between 4 major factors: (1) patient care, (2) education, (3) self, and (4) collegial relationships. Patient care was described as being at the center of professional responsibility, but it did not necessarily supersede other factors. Rather, patient care was described as a collective responsibility, operationalized through teamwork, communication, and trust. Traditional medical ethics have largely focused on professional responsibility from the standpoint of individual healthcare providers. Our findings suggest it is a much more complex construct characterized by competing responsibilities and an evolving perception of patient care as a collective responsibility. Explicit acknowledgment of this framework sets the stage for educational interventions to support residents' professional development and enhance cooperative behavior among participants.

  14. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Iso, Hiroyasu; Brown, David F M; Hasegawa, Kohei

    2017-08-23

    Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). In this population-based study of

  15. Global cancer surgery: delivering safe, affordable, and timely cancer surgery.

    Science.gov (United States)

    Sullivan, Richard; Alatise, Olusegun Isaac; Anderson, Benjamin O; Audisio, Riccardo; Autier, Philippe; Aggarwal, Ajay; Balch, Charles; Brennan, Murray F; Dare, Anna; D'Cruz, Anil; Eggermont, Alexander M M; Fleming, Kenneth; Gueye, Serigne Magueye; Hagander, Lars; Herrera, Cristian A; Holmer, Hampus; Ilbawi, André M; Jarnheimer, Anton; Ji, Jia-Fu; Kingham, T Peter; Liberman, Jonathan; Leather, Andrew J M; Meara, John G; Mukhopadhyay, Swagoto; Murthy, Shilpa S; Omar, Sherif; Parham, Groesbeck P; Pramesh, C S; Riviello, Robert; Rodin, Danielle; Santini, Luiz; Shrikhande, Shailesh V; Shrime, Mark; Thomas, Robert; Tsunoda, Audrey T; van de Velde, Cornelis; Veronesi, Umberto; Vijaykumar, Dehannathparambil Kottarathil; Watters, David; Wang, Shan; Wu, Yi-Long; Zeiton, Moez; Purushotham, Arnie

    2015-09-01

    Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

  16. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.

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

    Science.gov (United States)

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

    2016-06-01

    Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient. For an optimal outcome, the careful interdisciplinary selection of patients, preoperative risk evaluation and conditioning are essential. The caseload of the centres correlates inversely with the complication rate. The leading surgical complication is anastomotic leakage, which is diagnosed endoscopically and usually treated with the aid of endoscopic procedures. Pulmonary infections are the most frequent non-surgical complication. Thoracic epidural anaesthesia and perfusion-orientated fluid management can reduce the rate of pulmonary complications. Patients are ventilated protecting the lungs and are extubated as early as possible. Oesophagectomies should only be performed in high-volume centres with the close cooperation of surgeons and anaesthesia/intensive care specialists. Programmes of enhanced recovery after surgery (ERAS) hold further potential for the patient's quicker postoperative recovery. In this review article the fundamental aspects of the interdisciplinary perioperative management of transthoracic oesophagectomy are described.

  18. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation : two year results of a randomised controlled trial

    NARCIS (Netherlands)

    Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.

    2008-01-01

    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions

  19. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: Two year results of a randomised controlled trial

    NARCIS (Netherlands)

    W.C. Peul (Wilco); W.B. van den Hout (Wilbert); R. Brand (René); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)

    2008-01-01

    textabstractObjectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. I

  20. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

    NARCIS (Netherlands)

    Peul, W.C.; Hout, W.B. van den; Brand, R.; Thomeer, R.T.; Koes, B.W.; Eekhof, J.A.H.; Tans, J.T.; Houwelingen, H.C. van; Nuyten, M.; Bergman, P.; Holtkamp, G.; Dukker, S.; Mast, A.; Smakman, L.; Waanders, C.; Polak, P.; Nieborg, A.; Walchenbach, R.; Rossum, J. van; Schutte, P.J.; Verheul, G.A.; Dalman, J.A.; Wurzer, J.A.; Sven, J.W.; Kloet, A.; Merkies, I.S.; Dulken, H. van; Lambrechts, P.C.; Keunen, R.W.; Hoffmann, C.; Haan, J.; Groen, R.; Kuiters, R.R.; Roos, R.A.C.; Voormolen, J.H.

    2008-01-01

    OBJECTIVES: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. DESIGN: Randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with 6-12 weeks of sciatica. INTERVENTIONS

  1. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2015-06-01

    Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely   gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly.  Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of   provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.

  2. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    Directory of Open Access Journals (Sweden)

    Vincent Q. Trinh

    2016-01-01

    Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

  3. ANALYSIS OF METHODS OF AIRWAY MANAGEMENT IN MAXILLOFACIAL SURGERIES IN A TERTIARY CARE CENTRE AT PUDUCHERRY

    Directory of Open Access Journals (Sweden)

    Joseph Raajesh

    2016-02-01

    Full Text Available BACKGROUND Anaesthetic management of patients with oromaxillofacial surgeries poses quite a few challenges to both anaesthesiologist and operating surgeons. This is because the corrective procedure demands fixation of fractures, repair of soft tissue injuries and maintaining occlusion all without compromising the cosmetic aspect. Though securing the airway takes the precedence, it is of paramount importance that it should not interfere with the surgical techniques. METHODS Seventy one patients of maxillofacial injuries, operated over a period of five years between February 2011 and December 2015 in Indira Gandhi Medical College Hospital at Puducherry were reviewed. All patients were reviewed in relation to age, type of injury, etiology, bones involved and method of airway management. RESULTS The major etiology of injuries were road traffic accidents (79%. Majority of patients were young in the age group of 21-40 years (55%. Fracture mandible (46% was the most common injury. Airway secured by nasotracheal route with direct visualization of vocal cords was the most common (90%, followed by submental route (10%. CONCLUSION This analysis showed in maxillofacial procedures, trauma is the leading cause in this part of India also. Male preponderance, maximum injuries are seen in third and fourth decade of life and other findings that are correlating well with other studies. Nasotracheal intubation is the method of choice in securing the airway during the maxillofacial procedures. Submental intubation can be considered as a viable option when nasotracheal intubation is not possible due to the involvement of base of the skull or midfacial fractures.

  4. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic ...

  5. Value based care and bundled payments: Anesthesia care costs for outpatient oncology surgery using time-driven activity-based costing.

    Science.gov (United States)

    French, Katy E; Guzman, Alexis B; Rubio, Augustin C; Frenzel, John C; Feeley, Thomas W

    2016-09-01

    With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia record, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of different staffing ratios on anesthesia costs could be predicted. Costs for each of the procedures were determined. Process time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies and equipment represented the remaining 21%. Changing staffing ratios shows potential savings between 13% and 28% across the 11 procedures. TDABC can be used to estimate the costs of anesthesia care. This costing information is critical to assessing the anesthesiology component in a bundled payment. It can also be used to identify areas of cost savings and model costs of anesthesia care. CRNA to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be applied to other medical specialties to help determine costs in the setting of bundled payments. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Tests and visits before surgery

    Science.gov (United States)

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  7. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  8. Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

    Science.gov (United States)

    Dyson, Kate; Kruger, Estie; Tennant, Marc

    2012-12-01

    This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  9. Provider Network Development under the Department of Defense Coordinated Care Program: A Methodology for Primary Care Network Development and Its Implementation in the San Antonio Service Area

    Science.gov (United States)

    1993-04-01

    Administration Academy of Health Sciences , U.S. Army (HSHA-MH) Fort Sam Houston, TX 78234-6100’ N1 11. SUPPLEMENTARY NOTES 12a. DISTRIBUTION/ AVAILABILITY...Dallas/Ft Worth areas. San Antonio’s largest employers include several health care related organizations: University of Texas Health Science Center... physicall Conducted by Primary Care Manager for for ages 2-6. ages over 24 months. (For well baby $15 copayment per care up to 24 months of age, see

  10. Patients’ Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas

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    Annette M. Johansson

    2014-01-01

    Full Text Available Introduction. Video consultation (VC can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients’ experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.” Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients’ perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient’s perception of security during the VC encounter.

  11. Status of cardiac surgical intensive care medicine in Germany during 2013: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

    Science.gov (United States)

    Markewitz, Andreas; Trummer, Georg; Pilarczyk, Kevin; Beckmann, Andreas

    2014-10-01

    This report summarizes the results of a voluntary survey designed to assess the current situation of cardiac surgical intensive care medicine in Germany in 2013. standardized questionnaire concerning detailed information about structural characteristics of cardiac surgical intensive care units (ICUs) was sent to all German departments performing cardiac surgery. Participation quota resp. response rate was 100%. Compared with previous surveys since 1998, the total number of available intensive care capacities for patients after cardiac surgery increased to 1,404 beds, whereas the proportion of cardiac surgical ICUs decreased to 59% with a simultaneous increase of interdisciplinary ICUs. The proportion of cardiac surgeons acting as director of an ICU declined to 36%. The physicians' teams were predominantly interdisciplinary (74%). More than half of the directors were board-certified intensivists (54%), with a peak of 81% in ICUs run by cardiac surgeons. Human resources development in the ICU showed divergent trends with an increase of physicians and a decrease of nurses. Half of all ICUs (50%) and two-thirds of cardiac surgical ICUs (65%) offer an accredited training program for intensive care medicine. The results of this survey corroborate that intensive care medicine represents a substantial and important part of cardiac surgery. However, efforts are necessary to keep this attitude alive for the future. Georg Thieme Verlag KG Stuttgart · New York.

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

    Science.gov (United States)

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

    2015-06-01

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

  13. Multidisciplinary treatment of patients after a surgery due to cancers in the facial area: a clinical reports.

    Science.gov (United States)

    Rolski, D; Dolegacz, A; Górska, R; Mierzwińska-Nastalska, E

    2006-01-01

    Prosthetic rehabilitation of patients after surgical removal of carcinoma in the facial skeleton is one of the most difficult problems in therapy of the stomatognathic system, due to increasing incidence of head and neck carcinoma. Significant deformations of tissues, development of dysfunctions of the stomatognathic system with concurrent biological unbalance of the oral cavity enviroment are frequently a consequence of the treatment. Cicatricial scars, contraction of the oral crevice and limitation of mobility of the tongue are noted in numerous cases. Deformations of the facial area of the skull and of structures of the temporo-mandibular joint are also the reasons of occlusion and articulation disturbances. Two cases of surgery due to carcinoma in the facial skeleton that have required combined and stepwise multispecialistic treatment performed at Department of Prosthetic Dentistry and Department of Periodontology and Oral Disease, Dental Institute, Medical University of Warsaw are presented. The therapy has involved treatment of periodontitis and applying appropriate construction of prostheses that would relieve periodontium and splinting teeth.

  14. [Nursing care in ambulatory surgery at a teaching hospital: patients, procedures and biological and psychosocial needs].

    Science.gov (United States)

    Pinto, Tatiane Vegette; Araújo, Izilda Esmênia Muglia; Gallani, Maria Cecília Bueno Jayme

    2005-01-01

    This descriptive study aimed to characterize the profile of 167 subjects who were treated at the Ambulatory Surgical Center of a University Hospital in São Paulo State and procedures realized at the Ambulatory Surgical Center, as well as to identify the biological and psychosocial needs of these patients. Data were obtained through a semistructured interview and patients' files and were subject to descriptive analysis. The group was characterized by an equal number of individuals from both genders; average age was 51 years and socioeconomic levels were poor. The most common surgical and anesthetic procedures were ophthalmologic procedures and use of local anesthesia with or without sedation. The biological needs were: altered arterial pressure, electrocardiographic alterations, use of medication, allergy to medication, prolonged fasting, nausea, vomiting and pain. The psychosocial needs were: worry, fear, anxiety, discomfort caused by waiting for the realization of procedures and doubts or lack of information concerning perioperative care.

  15. Cirugía: un contexto diferente de cuidado Cirurgia: um contexto diferente de cuidados Surgery: a different care concept

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    Ángela María Salazar Maya

    2011-07-01

    fundamental theory. Data were collected through observation, informal and formal interviews to 20 patients, 19 nursing assistants and 8 nurses working in different second level surgical settings in the Valle de Aburra. Results: a theoretical scheme comprising twelve categories arises from data collected. This study shall present the category comprised in the following context: Working and being in a different area. It comprises the following subcategories: attention attracted by the environment, entering, being operated and going out, working under stress and team working. Final considerations: the surgical context, as any sphere, has an influence on nursing care; it supposes challenges for the nursing team regarding interactions, as they should be efficient and effective. The patient's status, his/her vulnerability, the risk implied by the anesthetic and surgical procedure, plus the simultaneousness of tasks faced by the nursing team makes their work stressful; therefore, the surgery service requires a nursing team capable of working under stress.

  16. Center of Cardiac Surgery Robotic Computerized Telemanipulation as Part of a Comprehensive Approach to Advanced Heart Care

    Science.gov (United States)

    2011-10-01

    Robotic OR Appendix E: Comparison Chart of daVinci Simulator Skill Sets and Training Exercise Activities 1 INTRODUCTION Robotic surgery recently...techniques in endoscopic cardiac bypass surgery is important not only for surgeons and surgical teams just beginning to perform robotic surgery , but also...Director, Robotic Surgery Scott Keith, PhD Faculty, Division of Biostatistics Rebecca O’Shea, MBA Senior Vice President for Clinical

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

    Science.gov (United States)

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

    2016-07-18

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

  18. Prehypertension and hypertension among young Indonesian adults at a primary health care in a rural area

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    Felix F. Widjaja

    2013-02-01

    Full Text Available Background: Prehypertension and hypertension were related with many complications of nearly every organ, but often neglected by young adults in rural area. This research was done to observe the prevalence of prehypertension and hypertension among young adult in a primary health care of rural area at Cicurug, Sukabumi District, West Java.Methods: This cross-sectional study was done in Cicurug Public Health Center, Sukabumi District, West Java. The subjects were consecutively recruited from the outpatient clinic on Monday until Saturday in September 2012,18–25 years old, not pregnant nor having shock. They were interviewed about their age, gender, physical activity, sitting hours, smoking habit, alcohol consumption, and family history and examined by trained health professionals (weight, height, body mass index [BMI], systolic and diastolic blood pressure.Results: From 111 young adults, 34.2% had prehypertension and 17.1% had hypertension. Within sex groups, the prevalence of prehypertension was higher in females, whereas hypertension was occurred more in males. Neither of family history from mother nor father were associated with prehypertension and hypertension compared with normotension. Total activity was not associated with prehypertension (OR = 2.6; p = 0.052 and hypertension (OR = 1.758; p = 0.498. BMI was associated with hypertension (OR = 3.354; p = 0.041 and not associated with prehypertension (OR = 2.343; p = 0.099.Conclusion: Prevalence of prehypertension and hypertension were relatively high among young adult in primary health care of rural area. Intervention to prevent further complications needs to be done early with lifestyle modification because blood pressure is associated with modifiable risk factors, such as BMI and total activity. (Med J Indones. 2013;22:39-45Keywords: Hypertension, prehypertension, rural area, young adult

  19. Quantifying innovation in surgery.

    Science.gov (United States)

    Hughes-Hallett, Archie; Mayer, Erik K; Marcus, Hani J; Cundy, Thomas P; Pratt, Philip J; Parston, Greg; Vale, Justin A; Darzi, Ara W

    2014-08-01

    The objectives of this study were to assess the applicability of patents and publications as metrics of surgical technology and innovation; evaluate the historical relationship between patents and publications; develop a methodology that can be used to determine the rate of innovation growth in any given health care technology. The study of health care innovation represents an emerging academic field, yet it is limited by a lack of valid scientific methods for quantitative analysis. This article explores and cross-validates 2 innovation metrics using surgical technology as an exemplar. Electronic patenting databases and the MEDLINE database were searched between 1980 and 2010 for "surgeon" OR "surgical" OR "surgery." Resulting patent codes were grouped into technology clusters. Growth curves were plotted for these technology clusters to establish the rate and characteristics of growth. The initial search retrieved 52,046 patents and 1,801,075 publications. The top performing technology cluster of the last 30 years was minimally invasive surgery. Robotic surgery, surgical staplers, and image guidance were the most emergent technology clusters. When examining the growth curves for these clusters they were found to follow an S-shaped pattern of growth, with the emergent technologies lying on the exponential phases of their respective growth curves. In addition, publication and patent counts were closely correlated in areas of technology expansion. This article demonstrates the utility of publically available patent and publication data to quantify innovations within surgical technology and proposes a novel methodology for assessing and forecasting areas of technological innovation.

  20. [Is the observation of patients with sleep-apnea-syndrome after surgery of the upper airway in an intensive care unit generally necessary?].

    Science.gov (United States)

    Kehrl, W; Schottke-Hennings, H; Offergeld, Ch; Grundmann, T

    2005-04-01

    Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU). 24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions. Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm. Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the

  1. Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Ferrua Marie

    2012-06-01

    Full Text Available Abstract Background Because breast cancer is a major public health issue, it is particularly important to measure the quality of the care provided to patients. Survival rates are affected by the timeliness of care, and waiting times constitute key quality criteria. The aim of this study was to develop and validate a set of quality indicators (QIs relative to the timeliness and organisation of care in new patients with infiltrating, non-inflammatory and metastasis-free breast cancer undergoing surgery. The ultimate aim was to use these QIs to compare hospitals. Methods The method of QI construction and testing was developed by COMPAQ-HPST. We first derived a set of 8 QIs from consensus guidelines with the aid of experts and professional associations and then tested their metrological properties in a panel of 60 volunteer hospitals. We assessed feasibility using a grid exploring 5 dimensions, discriminatory power using the Gini coefficient as a measure of dispersion, and inter-observer reliability using the Kappa coefficient. Results Overall, 3728 records were included in the analyses. All 8 QIs showed acceptable feasibility (but one QI was subject to misinterpretation, fairly strong agreement between observers (Kappa = 0.66, and wide variations in implementation among hospitals (Gini coefficient  Conclusions Of the 8 QIs, 3 are ready for nationwide implementation (time to surgery, time to postoperative multidisciplinary team meeting (MDTM, conformity of MDTM. Four are suitable for use only in hospitals offering surgery with on-site postoperative treatment (waiting time to first appointment after surgery, patient information, time to first postoperative treatment, and traceability of information relating to prognosis. Currently, in the French healthcare system, a patient receives cancer care from different institutions whose databases cannot as yet be easily merged. Nationwide implementation of QIs covering the entire care pathway will thus

  2. Children's environmental health: an under-recognised area in paediatric health care.

    Science.gov (United States)

    Gavidia, Tania G; Pronczuk de Garbino, Jenny; Sly, Peter D

    2009-02-06

    The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care.Over the past 15 years, world declarations and statements on children's rights, sustainable development, chemical safety and most recently climate change, have succeeded in cultivating a global focus on children's health and their right to a healthy environment. Many international calls for research in the area, have also been able to identify patterns of environmental diseases in children, assess children's exposures to many environmental toxicants, identify developmental periods of vulnerability, and quantify the cost benefits to public health systems and beyond, of addressing environmentally related diseases in children. Transferring this information to front-line health care providers and increasing their awareness about the global burden of disease attributed to the environment and children's special vulnerability to environmental threats is the salient aim of this commentary.

  3. Children's environmental health: an under-recognised area in paediatric health care

    Directory of Open Access Journals (Sweden)

    Sly Peter D

    2009-02-01

    Full Text Available Abstract The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care. Over the past 15 years, world declarations and statements on children's rights, sustainable development, chemical safety and most recently climate change, have succeeded in cultivating a global focus on children's health and their right to a healthy environment. Many international calls for research in the area, have also been able to identify patterns of environmental diseases in children, assess children's exposures to many environmental toxicants, identify developmental periods of vulnerability, and quantify the cost benefits to public health systems and beyond, of addressing environmentally related diseases in children. Transferring this information to front-line health care providers and increasing their awareness about the global burden of disease attributed to the environment and children's especial vulnerability to environmental threats is the salient aim of this commentary.

  4. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    Science.gov (United States)

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  5. Breast feeding practices and newborn care in rural areas: A descriptive cross-sectional study

    Directory of Open Access Journals (Sweden)

    Madhu K

    2009-01-01

    Full Text Available Context: Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in rural areas. Objectives: The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding. Settings and Design: The study was conducted in primary health care center (PHC that is attached to a medical college in Kengeri, rural Bangalore, Karnataka. Materials and Methods: Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data was collected using the pre-tested questionnaire on breastfeeding and newborn practices. Results: Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries. Conclusions: This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.

  6. Improving access to computer-based library and drug information services in patient-care areas.

    Science.gov (United States)

    Tobia, R C; Bierschenk, N F; Knodel, L C; Bowden, V M

    1990-01-01

    A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.

  7. [Breast feeding and child care: a case study of 2 rural areas of Mexico].

    Science.gov (United States)

    Pérez-Gil-Romo, S E; Rueda-Arróniz, F; Díez-Urdanivia-Coria, S

    1993-01-01

    The present research is included in the fields of public health, social sciences and gender studies. Its objective is to provide insight into the nursing behaviour of two groups of mothers, their domestic and extra-domestic child care arrangements and their attitudes towards breast-feeding. Thirty-five mothers were selected in Malinalco, Mexico, and 35 in the Sierra de Juárez, Oaxaca. Each mother had at least two children and one of them under three years of age. The study was exploratory in its initial phase, subsequently cross-sectional, comparative and prospective. It constitutes a foundation for longitudinal case studies. A pre-coded questionnaire, including the following issues, was administered: family composition; maternal schooling; maternal employment; nursing behaviour with the last child; child care and attitudes towards breast-feeding. The main information regarding 33 mothers in Malinalco and 31 in Oaxaca revealed that in both areas mothers decided how to feed their children during the first days; during the first month, 55 per cent of mothers in Malinalco breast-fed their child, while approximately 90 per cent did so in Oaxaca. The majority of women worked outside home and resorted to extra-domestic arrangements for child care. No relation was found between the feeding method chosen with the last child and maternal employment. About 90 per cent of women in both areas were "happy" to have been born females and breast-feeding was considered a "must". Seventy five per cent of mothers would not allow other women to breast feed their child, even though they were aware that maternal milk is the best.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. [Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study].

    Science.gov (United States)

    Fernández-Urrusuno, Rocío; Flores-Dorado, Macarena; Vilches-Arenas, Angel; Serrano-Martino, Carmen; Corral-Baena, Susana; Montero-Balosa, M Carmen

    2014-05-01

    To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. Cross-sectional study of prescription-indication. A primary health care area in Andalusia. Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  9. Attributes of Child Care Centers and Outdoor Play Areas Associated with Preschoolers' Physical Activity and Sedentary Behavior

    Science.gov (United States)

    Sugiyama, Takemi; Okely, Anthony D.; Masters, Jane M.; Moore, Gary T.

    2012-01-01

    This study examined characteristics of child care centers associated with preschoolers' moderate-to-vigorous physical activity and sedentary behavior while in child care (MVPA-C, SB-C), and attributes of outdoor play areas associated with the same behaviors during outdoor time (MVPA-O, SB-O). Participants were 89 children (3 -5 years) recruited…

  10. Does point of care prothrombin time measurement reduce the transfusion of fresh frozen plasma in patients undergoing major surgery? The POC-OP randomized-controlled trial

    Directory of Open Access Journals (Sweden)

    Alberio Lorenzo

    2009-11-01

    Full Text Available Abstract Background Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP, is often live saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. Consequently, strategies to optimize the decision to transfuse are needed. Bleeding during surgery is a dynamic process and may result in major blood loss and coagulopathy due to dilution and consumption. The indication for transfusion should be based on reliable coagulation studies. While hemoglobin levels and platelet counts are available within 15 minutes, standard coagulation studies require one hour. Therefore, the decision to administer FFP has to be made in the absence of any data. Point of care testing of prothrombin time ensures that one major parameter of coagulation is available in the operation theatre within minutes. It is fast, easy to perform, inexpensive and may enable physicians to rationally determine the need for FFP. Methods/Design The objective of the POC-OP trial is to determine the effectiveness of point of care prothrombin time testing to reduce the administration of FFP. It is a patient and assessor blind, single center randomized controlled parallel group trial in 220 patients aged between 18 and 90 years undergoing major surgery (any type, except cardiac surgery and liver transplantation with an estimated blood loss during surgery exceeding 20% of the calculated total blood volume or a requirement of FFP according to the judgment of the physicians in charge. Patients are randomized to usual care plus point of care prothrombin time testing or usual care alone without point of care testing. The primary outcome is the relative risk to receive any FFP perioperatively. The inclusion of 110 patients per group will yield more than 80% power to detect a clinically relevant relative risk

  11. A comparative analysis of predictive models of morbidity in intensive care unit after cardiac surgery – Part I: model planning

    Directory of Open Access Journals (Sweden)

    Biagioli Bonizella

    2007-11-01

    Full Text Available Abstract Background Different methods have recently been proposed for predicting morbidity in intensive care units (ICU. The aim of the present study was to critically review a number of approaches for developing models capable of estimating the probability of morbidity in ICU after heart surgery. The study is divided into two parts. In this first part, popular models used to estimate the probability of class membership are grouped into distinct categories according to their underlying mathematical principles. Modelling techniques and intrinsic strengths and weaknesses of each model are analysed and discussed from a theoretical point of view, in consideration of clinical applications. Methods Models based on Bayes rule, k-nearest neighbour algorithm, logistic regression, scoring systems and artificial neural networks are investigated. Key issues for model design are described. The mathematical treatment of some aspects of model structure is also included for readers interested in developing models, though a full understanding of mathematical relationships is not necessary if the reader is only interested in perceiving the practical meaning of model assumptions, weaknesses and strengths from a user point of view. Results Scoring systems are very attractive due to their simplicity of use, although this may undermine their predictive capacity. Logistic regression models are trustworthy tools, although they suffer from the principal limitations of most regression procedures. Bayesian models seem to be a good compromise between complexity and predictive performance, but model recalibration is generally necessary. k-nearest neighbour may be a valid non parametric technique, though computational cost and the need for large data storage are major weaknesses of this approach. Artificial neural networks have intrinsic advantages with respect to common statistical models, though the training process may be problematical. Conclusion Knowledge of model

  12. A Survey on Awareness about the Role of Anesthesia and Anesthesiologists among the Patients Undergoing Surgeries in a Tertiary Care Teaching Women and Children Hospital

    Science.gov (United States)

    Marulasiddappa, Vinay; Nethra, H. N.

    2017-01-01

    Background: Although anesthesiology has grown tremendously and although anesthesiologists play a crucial role in the perioperative management of patients and also outside operating theater (OT) such as critical care, pain clinic, and labor analgesia, they do not get due recognition. We conducted a study to assess the awareness about the role of anesthesia and anesthesiologists among patients scheduled to undergo surgery in a Government Tertiary Care Teaching Women and Children Hospital. Designs: A prospective cross-sectional survey with a sample size of 100 patients. Materials and Methods: Patients scheduled to undergo elective surgery in the age group of 18–65 years with the American Society of Anesthesiologists (ASA) Grades 1 and 2, who are willing to participate and given written informed consent. Patients whose age 0.05) between those with previous surgery and those without previous surgery regarding their knowledge of anesthesiology and anesthesiologist. Ninety percent did not know the complications, types of anesthesia and 44% did not know that anesthesiologist is a doctor. Conclusion: Most of the participants were not aware of the role of anesthesia and anesthesiologists inside and outside OT. Although this could be attributed to their lower level of education, the fraternity of anesthesiologists has to educate patients and surgeons about the role of anesthesia. PMID:28298774

  13. Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas

    Directory of Open Access Journals (Sweden)

    Nyamtema Angelo S

    2011-11-01

    Full Text Available Abstract Background With 15-30% met need for comprehensive emergency obstetrical care (CEmOC and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. Considering severe shortage of human resources for health in the country, currently operating at 32% of the required skilled workforce, an intensive three-month course was developed to train non-physician clinicians for remote health centres. Methods Competency-based curricula for assistant medical officers' (AMOs training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centres Results A total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7 and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4. There were two maternal deaths, both arriving in a moribund condition. Conclusions Tanzanian AMOs, clinical officers, and nurse-midwives can be trained as

  14. The Effect of Mobile App Follow-up Care on the Number of In-person Visits Following Ambulatory Surgery: A Randomized Control Trial.

    Science.gov (United States)

    Armstrong, Kathleen; Coyte, Peter; Semple, John

    2015-01-01

    Women's College Hospital (WCH) in Toronto offers specialized ambulatory surgical procedures. A feasibility study using a mobile appliciation (app) to supplement in-person follow-up care after surgery suggests that the mobile app adequately detects postoperative complications, eliminates the need for in-person follow-up care and is cost-effective. This is concordant with other postoperative telemedicine studies. The purpose of this study is to determine if we can avert in-person follow-up care through the use of mobile app compared to conventional, in-person follow-up care in the first month following surgery amongst breast reconstruction patients at WCH. This will be a pragmatic, single-centre, open, controlled, 2-arm parallel-group superiority randomized trial. Mobile app follow-up care is a novel approach to managing patients postoperatively with the potential to avert in-person follow-up and generate cost-savings for the healthcare system and patient.

  15. The checkerboard area health system: delivering comprehensive care in a remote region of New Mexico.

    Science.gov (United States)

    Reid, R A; Bartlett, E E; Kozoll, R

    1982-01-01

    A comprehensive health center is defined as the synergistic coupling of a medical and administrative structure designed to provide inpatient, outpatient, and public health services. While health centers have been widely established in other countries, only limited implementation has occurred in rural areas of the United States. The successful implementation of the health center concept in a sparsely populated area of northwestern New Mexico, which is predominately inhabited by Navajo Indians and Spanish Americans, is descriptively analyzed. The physical environment and the socioeconomic characteristics of the catchment area residents are related to dominant conditions in underdeveloped countries. The evolution of the delivery system with its network of satellite clinics staffed by mid-level primary care providers is documented. The funding and provision of a wide range of preventive and curative health services supported by communication, transportation, outreach, education, public health, and administration components are described. Several problems thought to impede the application of the health center concept to other regions in the United States are identified and discussed relative to this New Mexican experience. Innovative and persevering systems designers who are strongly committed to delivering a balance between preventive and curative services are considered to be absolutely necessary for successful implementation of the health center concept in the United States.

  16. The relationship between fixed and rotating shifts with job burnout in nurses working in critical care areas

    DEFF Research Database (Denmark)

    Shahriari, Mohsen; Shamali, Mahdi; Yazdannik, Ahmadreza

    2014-01-01

    BACKGROUND: While critical care nurses are vulnerable to burnout because of the complex nature of patients' health problems, working in critical care areas has become even more complicated by shift working schedules. This study aimed to determine the relationship between fixed and rotating shifts...... and burnout in a sample of critical care nurses working in critical care areas. MATERIALS AND METHODS: In this retrospective cohort design, 170 critical care nurses from six selected hospitals were chosen using quota and random sampling and divided into two groups (exposed and non-exposed). Maslach Burnout...... no significant difference in the two groups. Furthermore, the non-exposed group had 10.1 times the odds to expose to EE and 2.2 times the odds to expose to DP in comparison with the exposed group. High levels of burnout in the non-exposed group were 60%, 32.9%, and 27.1%, and in the exposed group were 12.9%, 18...

  17. [Analysis of knowledge attitudes and practices of health care workers facing blood exposure accidents in a general surgery service].

    Science.gov (United States)

    Ennigrou, Samir; Ben Ameur Khechine, Imène; Cherif, Ali; Najah, Nabil; Ben Hamida, Abdelmajid

    2004-06-01

    In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35.7 years. The sex ratio is 0.7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood (95.6%), but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71.2% of investigated. The majority of investigated declare to know universal precaution principles (85.8%). However, to the maximum 4 measures only on the 10 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficiently known by our sample. It is represented, in 78.8% of cases, in the application of disinfectants Betadine type or alcohol iodized, whereas the practice of a serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months (n = 44) didn't declare their blood exposure accident and only 11.4% declare to have undergone cares. Actions of information and formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial.

  18. Pharmaceutical Care for the Patient after Cardiac Surgery%心脏术后患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    陈岷; 童荣生; 黄晓波

    2011-01-01

    目的:临床药师参与临床药物治疗,对患者进行药学监护.方法:以一位心脏术后患者为例,临床药师参与药物治疗方案的制订,分析患者所用相关药物,跟踪其治疗效果及不良反应,对药物治疗过程进行综合评估.结果:患者的各项指标趋于正常.结论:临床药师的参与使药物治疗更趋合理,在达到治疗目标的同时,可减少药物的不良反应,有利于提高临床的药物治疗水平.%Objective: Clinical pharmacists involved in clinical drug therapy and pharmaceutical care for patients and cooperated with clinicians in order to promote rational drug use in clinics. Method: Clinical pharmacists involved in therapeutic scheme making, medication analysis and evaluation,such as anticoagulant drugs,antibiotics,cardiac drugs,and diuretics,etc. Used in the patient after cardiac surgery,and made a comprehensive drug treatment assessment including effectiveness and adverse reactions in whole therapy process. Result: All the indices of the patient trended toward normal. Conclusion: The participation of clinical pharmacists in clinical treatment team and clinical practice can make drug treatment more rational with therapeutic goal reached and adverse drug reactions reduced to improve the level of clinical drug treatment.

  19. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.

    Science.gov (United States)

    Peyton, Philip J; Chong, Simon W

    2010-11-01

    When assessing the accuracy and precision of a new technique for cardiac output measurement, the commonly quoted criterion for acceptability of agreement with a reference standard is that the percentage error (95% limits of agreement/mean cardiac output) should be 30% or less. We reviewed published data on four different minimally invasive methods adapted for use during surgery and critical care: pulse contour techniques, esophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bioimpedance, to assess their bias, precision, and percentage error in agreement with thermodilution. An English language literature search identified published papers since 2000 which examined the agreement in adult patients between bolus thermodilution and each method. For each method a meta-analysis was done using studies in which the first measurement point for each patient could be identified, to obtain a pooled mean bias, precision, and percentage error weighted according to the number of measurements in each study. Forty-seven studies were identified as suitable for inclusion: N studies, n measurements: mean weighted bias [precision, percentage error] were: pulse contour N = 24, n = 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57: -0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8, n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N = 13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has achieved agreement with bolus thermodilution which meets the expected 30% limits. The relevance in clinical practice of these arbitrary limits should be reassessed.

  20. Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees.

    Science.gov (United States)

    Wong, Edwin S; Hebert, Paul L; Nelson, Karin M; Hernandez, Susan E; Sylling, Philip W; Fihn, Stephan D; Liu, Chuan-Fen

    2015-08-01

    Prior research examining the relationship between economic conditions and health service demand has focused primarily on outpatient use. This study examines whether local area unemployment, as an indicator of economic conditions, was associated with use of inpatient care, which is theoretically less subject to discretionary use. Using a random sample of 131,603 patients dually enrolled in the Veterans Affairs (VA) Health System and fee-for-service Medicare, we measured VA, Medicare, and total (VA and Medicare) hospitalizations. Overall, local unemployment was not associated with VA, Medicare, or total hospitalization probability. Among low-income veterans exempt from VA copayments, higher local unemployment was moderately associated with a lower probability of hospitalization through Medicare. For veterans subject to VA copayments, higher local unemployment was moderately associated with a higher likelihood of VA hospitalization. These results suggest inpatient use is less sensitive to the economy, although worse economic conditions slightly affected inpatient demand for select veterans. © The Author(s) 2015.

  1. Implementation of the principles of primary health care in a rural area of South Africa

    Directory of Open Access Journals (Sweden)

    Surona Visagie

    2014-01-01

    Full Text Available Background: The philosophy of primary healthcare forms the basis of South Africa’s health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas.Objectives: The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa.Method: A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis.Results: Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, healthworker attitudes, referral services and the management of complex conditions.Conclusion: The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcareservices and increasing the doctors’ hours.

  2. Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery.

    Science.gov (United States)

    Sun, Li-Min; Huang, Eng-Yen; Liang, Ji-An; Meng, Fan-Yun; Chang, Gia-Hsin; Tsao, Min-Jen

    2013-03-06

    To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations.

  3. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments m...

  4. A Subacute Care Intervention for Short-Stay Breast Cancer Surgery Self-Test Kit: Rapid Diagnosis of Urogenital Infections in Military Women

    Science.gov (United States)

    1998-10-01

    Betsy McCaughey Ross, to push Congress to pass a 48-hour minimum stay law, similar to the one that already covers birthing 𔃿 . In California’s...DDetroitArea 0Charlotte 0Other Date of Surgery: / /___ Date of Birth : / / Pre-Surg. Height: cm Surgery Side: oRight DLeft oBoth Pre-Surg. Weight...is a lotus blossom which represents the fragile beauty of life. The fairy magically dusting the flower represents the body’s amazing ability to renew

  5. Developing the Storyline for an Advance Care Planning Video for Surgery Patients: Patient-Centered Outcomes Research Engagement from Stakeholder Summit to State Fair.

    Science.gov (United States)

    Aslakson, Rebecca A; Schuster, Anne L R; Lynch, Thomas J; Weiss, Matthew J; Gregg, Lydia; Miller, Judith; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Volandes, Angelo E; Smith, Thomas J; Bridges, John F P

    2017-08-17

    Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. The objective is to develop and test acceptability of an ACP video storyline. The design is a stakeholder-guided development of the ACP video storyline. Design-thinking methods explored and prioritized stakeholder perspectives. Patients and family members evaluated storyboards containing the proposed storyline. The study was conducted at hospital outpatient surgical clinics, in-person stakeholder summit, and the 2014 Maryland State Fair. Measurements are done through stakeholder engagement and deidentified survey. Stakeholders evaluated and prioritized evidence from an environmental scan. A surgeon, family member, and palliative care physician team iteratively developed a script featuring 12 core themes and worked with a medical graphic designer to translate the script into storyboards. For 10 days, 359 attendees of the 2014 Maryland State Fair evaluated the storyboards and 87% noted that they would be "very comfortable" or "comfortable" seeing the storyboard before major surgery, 89% considered the storyboards "very helpful" or "helpful," and 89% would "definitely recommend" or "recommend" this story to others preparing for major surgery. Through an iterative process utilizing diverse PCOR engagement methods and informed by SLT, storyboards were developed for an ACP video. Field testing revealed the storyline to be highly meaningful for surgery patients and family members.

  6. Impact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas.

    Science.gov (United States)

    Sun, Guo-Chen; Wang, Fei; Chen, Xiao-Lei; Yu, Xin-Guang; Ma, Xiao-Dong; Zhou, Ding-Biao; Zhu, Ru-Yuan; Xu, Bai-Nan

    2016-12-01

    The utility of virtual and augmented reality based on functional neuronavigation and intraoperative magnetic resonance imaging (MRI) for glioma surgery has not been previously investigated. The study population consisted of 79 glioma patients and 55 control subjects. Preoperatively, the lesion and related eloquent structures were visualized by diffusion tensor tractography and blood oxygen level-dependent functional MRI. Intraoperatively, microscope-based functional neuronavigation was used to integrate the reconstructed eloquent structure and the real head and brain, which enabled safe resection of the lesion. Intraoperative MRI was used to verify brain shift during the surgical process and provided quality control during surgery. The control group underwent surgery guided by anatomic neuronavigation. Virtual and augmented reality protocols based on functional neuronavigation and intraoperative MRI provided useful information for performing tailored and optimized surgery. Complete resection was achieved in 55 of 79 (69.6%) glioma patients and 20 of 55 (36.4%) control subjects, with average resection rates of 95.2% ± 8.5% and 84.9% ± 15.7%, respectively. Both the complete resection rate and average extent of resection differed significantly between the 2 groups (P virtual and augmented reality based on functional neuronavigation and intraoperative MRI can facilitate resection of gliomas involving eloquent areas. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Infections in outpatient surgery.

    Science.gov (United States)

    Nazarian Mobin, Sheila S; Keyes, Geoffrey R; Singer, Robert; Yates, James; Thompson, Dennis

    2013-07-01

    In the plastic surgery patient population, outpatient surgery is cost effective and will continue to grow as the preferred arena for performing surgery in healthy patients. Although there is a widespread myth that outpatient surgery centers may suffer from increased infection rates due to lax infection control, the data presented from American Association for Accreditation of Ambulatory Surgery Facilities-accredited facilities prove the contrary. There is a lack of data investigating infection prevention in the perioperative period in plastic surgery patients. As data collection becomes more refined, tracking the postoperative care environment should offer additional opportunities to lower the incidence of postoperative infections.

  8. Status of emergency obstetric care in a local government area in south-south Nigeria.

    Science.gov (United States)

    Mezie-Okoye, Margaret M; Adeniji, Foluke O; Tobin-West, Charles I; Babatunde, Seye

    2012-09-01

    This study assessed the status of the availability and performance of emergency obstetric care (EmOC) in 12 functional public health facilities out of the existing 19 in Gokana Local Government Area of Rivers State in south-south Nigeria, prior to the midwives service scheme (MSS) launch in 2009. No facility qualified as basic EmOC, while one had comprehensive EmOC status. Signal functions that required supply of medical consumables were performed by more facilities than services that required special training, equipment and maintenance. Only two facilities (16.67%) had the minimum requirement of > or =4 midwives for 24-hour EmOC service; while only 2.2% of expected births occurred at the facilities. The poor state of maternal health resources in the study area requires urgent interventions by Local and State Governments for infrastructure upgrade and deployment and training of staff towards attainment of MDG-5. A follow-up evaluation would be required since the commencement of the MSS.

  9. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN).

    Science.gov (United States)

    Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J

    2016-08-31

    Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology

  10. The 1998, 1999 patterns of care study for breast irradiation after breast-conserving surgery in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Chang Ok; Cho, Jae Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Shin, Hyun Soo [Pochon CHA University College of Medicine, Pochon (Korea, Republic of)] (and others)

    2004-09-15

    To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techniques, nationwide survey was performed. A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998 {approx} 1999 from 15 hospitals were reviewed. The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the cases, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one received more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast + supraclavicular fossa (SCL) in 5% of the cases, and breast + SCL + posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation, Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45

  11. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge;

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments...... might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway....

  12. Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery.

    Science.gov (United States)

    Ligh, Cassandra A; Fox, Justin P; Swanson, Jordan; Yu, Jason W; Taylor, Jesse A

    2016-06-01

    This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p cleft palate were most likely to return to the hospital (p cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.

  13. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT).

    Science.gov (United States)

    Rijkenberg, Saskia; Stilma, Willemke; Bosman, Robert J; van der Meer, Nardo J; van der Voort, Peter H J

    2017-08-01

    The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery. A prospective, observational cohort study. A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands. The study comprised 72 consecutive intubated and mechanically ventilated patients after cardiac surgery who were not able to self-report pain. Two nurses assessed the BPS and CPOT simultaneously and independently at the following 4 moments: rest, a nonpainful procedure (oral care), rest, and a painful procedure (turning). Both scores showed a significant increase of 2 points between rest and turning. The median BPS score of nurse 1 showed a significant increase of 1 point between rest and the nonpainful procedure (oral care), whereas both median CPOT scores did not change. The interrater reliability of the BPS and CPOT showed fair-to-good agreement of 0.74 overall. During the periods of rest 1 and rest 2, values ranged from 0.24 to 0.46. Cronbach's alpha values for the BPS were 0.62 (nurse 1) and 0.59 (nurse 2) compared with 0.65 and 0.58, respectively, for the CPOT. The BPS and CPOT are reliable and valid pain assessment tools in a daily clinical setting. However, the discriminant validation of both scores seems less satisfactory in sedated or agitated patients and this topic requires further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Proposed maximum surgical blood ordering schedule for common orthopedic surgeries in a Tertiary Health - Care Center in Northern India

    Directory of Open Access Journals (Sweden)

    Sonam Kumari

    2017-01-01

    CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.

  15. Estimating Lifetime Costs of Social Care: A Bayesian Approach Using Linked Administrative Datasets from Three Geographical Areas.

    Science.gov (United States)

    Steventon, Adam; Roberts, Adam

    2015-12-01

    We estimated lifetime costs of publicly funded social care, covering services such as residential and nursing care homes, domiciliary care and meals. Like previous studies, we constructed microsimulation models. However, our transition probabilities were estimated from longitudinal, linked administrative health and social care datasets, rather than from survey data. Administrative data were obtained from three geographical areas of England, and we estimated transition probabilities in each of these sites flexibly using Bayesian methods. This allowed us to quantify regional variation as well as the impact of structural and parameter uncertainty regarding the transition probabilities. Expected lifetime costs at age 65 were £20,200-27,000 for men and £38,700-49,000 for women, depending on which of the three areas was used to calibrate the model. Thus, patterns of social care spending differed markedly between areas, with mean costs varying by almost £10,000 (25%) across the lifetime for people of the same age and gender. Allowing for structural and parameter uncertainty had little impact on expected lifetime costs, but slightly increased the risk of very high costs, which will have implications for insurance products for social care through increasing requirements for capital reserves.

  16. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery

    DEFF Research Database (Denmark)

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo;

    2014-01-01

    all patients undergoing CRC surgery in the period 2005-2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan......-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. RESULTS: We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among...... patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among...

  17. A Secure Cloud-Assisted Wireless Body Area Network in Mobile Emergency Medical Care System.

    Science.gov (United States)

    Li, Chun-Ta; Lee, Cheng-Chi; Weng, Chi-Yao

    2016-05-01

    Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time information about patients' health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients' lives. Since the patient's data is sensitive and private, it is important to provide strong security and protection on the patient's medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring.

  18. Family Centered Approach in Primary Health Care: Experience from an Urban Area of Mangalore, India

    Directory of Open Access Journals (Sweden)

    Siddharudha Shivalli

    2015-01-01

    Full Text Available Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P<0.05 and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable.

  19. [Basic standards for a department of cardiac surgery. Quality requirements for the care of cardiac patients in connection with operations on the heart, the heart vessels and thoracic organ transplantation].

    Science.gov (United States)

    Beckmann, Andreas; Beyersdorf, F; Diegeler, A; Mohr, F W; Welz, A; Rein, J-G; Cremer, J

    2013-12-01

    Current evolutions and substantial amendments of the German health care system in combination with distinguished progress in cardiac surgery over the past years require both a reflection of principles in patient-centered care and an update of basic standard requirements for a department of cardiac surgery in Germany. In due consideration of the data from the voluntary registry of the German Society for Thoracic and Cardiovascular Surgery, this article accurately defines core requirements for a cardiac surgical department (cardiac surgery on-site), subdivided into facilities, staff and processes. If based on these standards, one may anticipate that cardiac surgical care is performed under appropriate conditions leading to an intrinsic benefit for patients.

  20. Measuring satisfaction: factors that drive hospital consumer assessment of healthcare providers and systems survey responses in a trauma and acute care surgery population.

    Science.gov (United States)

    Kahn, Steven A; Iannuzzi, James C; Stassen, Nicole A; Bankey, Paul E; Gestring, Mark

    2015-05-01

    Hospital quality metrics now reflect patient satisfaction and are measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Understanding these metrics and drivers will be integral in providing quality care as this process evolves. This study identifies factors associated with patient satisfaction as determined by HCAHPS survey responses in trauma and acute care surgery patients. HCAHPS survey responses from acute care surgery and trauma patients at a single institution between 3/11 and 10/12 were analyzed. Logistic regression determined which responses to individual HCAHPS questions predicted highest hospital score (a rating of 9-10/10). Demographic and clinical variables were also analyzed as predictors of satisfaction. Subgroup analysis for trauma patients was performed. In 70.3 per cent of 182 total survey responses, a 9-10/10 score was given. The strongest predictors of highest hospital ranking were respect from doctors (odds ratio [OR] = 24.5, confidence interval [CI]: 5.44-110.4), doctors listening (OR: 9.33, CI: 3.7-23.5), nurses' listening (OR = 8.65, CI: 3.62-20.64), doctors' explanations (OR = 8.21, CI: 3.5-19.2), and attempts to control pain (OR = 7.71, CI: 3.22-18.46). Clinical factors and outcomes (complications, intensive care unit/hospital length of stay, mechanism of injury, and having an operation) were nonsignificant variables. For trauma patients, Injury Severity Score was inversely related to score (OR = 0.93, CI: 0.87-0.98). Insurance, education, and disposition were also tied to satisfaction, whereas age, gender, and ethnicity were nonsignificant. In conclusion, patient perception of interactions with the healthcare team was most strongly associated with satisfaction. Complications did not negatively influence satisfaction. Insurance status might potentially identify patients at risk of dissatisfaction. Listening to patients, treating them with respect, and explaining the care plan are integral to a

  1. Comparison of neonatal intensive care: Trento area versus Vermont Oxford Network

    Directory of Open Access Journals (Sweden)

    Pederzini Fabio

    2009-03-01

    Full Text Available Abstract Background S. Chiara hospital is the only neonatal intensive care unit (NICU in the Province of Trento (Italy. It serves a population of about 460000 people with about 5000 infants per year, admitting the totality of the inborn and outborn VLBWI of the province. The aim of this work is to compare mortality, morbidity and neonatal treatment of the very low birth weight infants (VLBWI of Trento area with those recorded in the Vermont Oxford Network (VON during 2004. Methods In this retrospective analysis, the rates of complications and related treatments reported in VLBWI admitted in the S. Chiara NICU during the period 2000–2005 were compared with those recorded in the VON in 2004. The analysis included both the total populations and different weight groups. Results The frequency of inborn infants was significantly higher in Trento than in VON: 91% vs 84% (MH 8.56; p-value 0.003. The administration of prenatal steroids (82% vs 74%; MH 7.47 and p-value 0.006 and caesarean section were significantly more frequent in the Trento area than in VON. In Trento significantly more VLBWI with BW ≤ 1000 grams were given surfactant prophylaxis compared with VON and significantly fewer VLBWI in every Trento weight group developed RDS (MH 18.55; p-value 0.00001. Overall rates of complications (CLD, PDA, NEC, IVH were significantly lower than in the Vermont Oxford Network. In CLD and PDA the differences were marked also in infants weighting less than 1000 grams. Overall rates of PNX, PVL, severe grade of ROP and mortality were similar in the two populations. In Trento, significantly more infants were discharged on human milk than in VON, in both the overall population and in BW sub-groups. Conclusion On the basis of this analysis, a less aggressive therapeutic strategy based on perinatal prevention in global management, such as that employed in Trento area, may be associated with an improvement in clinical outcomes in very low birth weight infants.

  2. Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study.

    Science.gov (United States)

    Lebherz-Eichinger, Diana; Tudor, Bianca; Krenn, Claus G; Roth, Georg A; Seemann, Rudolf

    2016-04-01

    Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection and length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5 ± 2.5 versus 6.1 ± 4.6 days, P < 0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1 ± 3.8 versus 9.2 ± 6.2 days, P < 0.001), leading to calculated cost savings of about 8000 Euro per patient. Length of operation negatively influenced length of ICU stay (P < 0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

  3. Pain relief in day care arthroscopic knee surgery: A comparison between intra-articular ropivacaine and levobupivacaine: A prospective, double-blinded, randomized controlled study

    Directory of Open Access Journals (Sweden)

    Anjan Das

    2014-01-01

    Full Text Available Background: Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anesthetic drugs and routes of administration. Aims: The aim of the present study was carried out to compare the efficacy of ropivacaine and levobupivacaine when administered through intra-articular route in controlling pain after day care arthroscopic knee surgery. Setting and Design: It was a prospective, double-blinded and randomized controlled study. Materials and Methods: April 2008-December 2008, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing day care arthroscopic knee surgery were randomly assigned into two groups (R, L. Group R received 10 ml of 0.75% ropivacaine, whereas group L received 10 ml of 0.50% levobupivacaine through intra-articular route at the end of the procedure. Pain assessed using visual analog scale (VAS and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were calculated. Statistical Analysis and Results: based on comparable demographic profiles; time for the requirement of first post-operative rescue analgesia (242.16 ± 23.86 vs. 366.62 ± 24.42 min and total mean rescue analgesic requirement was (104.35 ± 18.96 vs. 76.82 ± 14.28 mg in group R and L respectively. Group R had higher mean VAS score throughout the study period. No side effects found among the groups. These two results were clinically and statistically significant (P < 0.05. Conclusion: Hence, it was evident that intra-articular levobupivacaine give better post-operative pain relief, with an increase in time of first analgesic request and decreased need of total post-operative analgesia compared with ropivacaine.

  4. Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology - head and neck surgery.

    Science.gov (United States)

    Scott, John R; Wong, Eric; Sowerby, Leigh J

    2015-12-29

    No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario. PCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics. A total of 50 PCPs were surveyed. Subspecialty influenced 90.0% of the referrals made. Specialist wait times altered 58.0% of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74% of PCPs. Improvements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered.

  5. Bariatric Surgery

    Science.gov (United States)

    ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese to ... What are the endocrine-related benefits of bariatric surgery? Bariatric surgery and the weight loss that results can: ...

  6. Surgery center joint ventures.

    Science.gov (United States)

    Zasa, R J

    1999-01-01

    Surgery centers have been accepted as a cost effective, patient friendly vehicle for delivery of quality ambulatory care. Hospitals and physician groups also have made them the vehicles for coming together. Surgery centers allow hospitals and physicians to align incentives and share benefits. It is one of the few types of health care businesses physicians can own without anti-fraud and abuse violation. As a result, many surgery center ventures are now jointly owned by hospitals and physician groups. This article outlines common structures that have been used successfully to allow both to own and govern surgery centers.

  7. Patterns and Determinants of Essential Newborn Care Practices in Rural Areas of Northern Ghana

    Directory of Open Access Journals (Sweden)

    Mahama Saaka

    2014-01-01

    Full Text Available Background. This study was designed to understand the patterns and determinants of three essential newborn care practices: safe cord care, optimal thermal care, and neonatal feeding practices. Methods. A community-based cross-sectional study was carried out on a sample of 404 lactating mothers who have delivered a live baby at home within the past one year prior to the study. Results. Overall, the prevalence of essential newborn practices on safe cord care and optimal thermal care was exceptionally low. Of the 404 newborns, only 0.2% (1 had safe cord care, 5.2% (21 optimal thermal care, and 50.2% (203 were considered to have had adequate neonatal feeding. In logistic regression analysis, the main predictors of good neonatal feeding were maternal age, timing of the first antenatal care (ANC, and maternal knowledge of newborn danger signs. Women who could mention at least 4 danger signs of the neonate were 4 times more likely to give good neonatal feeding to their babies (AOR = 4.7, Cl: 2.43–9.28, P<0.001. Conclusion. Evidence from this study strongly suggests that the expected essential newborn care practices are not available to a substantial number of the newborns. Efforts should therefore be made by the Ghana Health Service (GHS to expand essential newborn care interventions beyond institutional level into the communities.

  8. Quality assurance review of training in oral and maxillofacial surgery by the General Medical Council: areas of good practice, requirements, and recommendations.

    Science.gov (United States)

    Sandhu, Davinder P S; Dover, Michael Stephen; Lay, Sarah

    2016-04-01

    The purpose of this paper is to disseminate the outcome of the 2012/13 UK-wide quality assurance review of postgraduate training in oral and maxillofacial surgery (OMFS) by the General Medical Council (GMC), as part of its review of small specialties. OMF surgeons need to be aware of the evidence on which the conclusions are based, and to know about the strengths of the specialty and the areas for future development so that postgraduate training, and ultimately the outcomes for patients, can be improved. This paper, by the authors involved in the review, summarises the salient points and is not a verbatim report. Copyright © 2016. Published by Elsevier Ltd.

  9. Sanitation in classroom and food preparation areas in child-care facilities in North Carolina and South Carolina.

    Science.gov (United States)

    Wohlgenent, Kelly C; Cates, Sheryl C; Fraser, Angela; Chapman, Benjamin; Jaykus, Lee-Ann; Chen, Xi

    2014-11-01

    Approximately 60% of U.S. children aged five and younger spend time in child-care settings. Such environments increase the risk of diarrheal disease, including diseases caused by enteric pathogens. To describe adherence to sanitation standards in classrooms and food preparation areas in child-care facilities, the authors conducted site visits in 40 North Carolina and South Carolina child-care facilities. Audits in up to two classrooms (rooms providing care for infants and toddlers) and the kitchen were performed using a form similar to a regulatory inspection form. Audit data were used to calculate indices to describe adherence to sanitation standards and were based on state environmental health regulations for child-care centers, the Food and Drug Administration's Food Code 2009, and guidance from food safety experts. Most facilities participating in the authors' study adhered to sanitation standards within the classroom; however, deficiencies with regard to sanitation in food preparation areas and refrigerator operating temperatures were noted. These results provide insight into possible risk factors for enteric disease transmission in child-care facilities.

  10. Can money buy green? Demographic and socioeconomic predictors of lawn-care expenditures and lawn greenness in urban residential areas

    Science.gov (United States)

    Weiqi Zhou; Austin Troy; J. Morgan Grove; Jennifer C. Jenkins

    2009-01-01

    It is increasingly important to understand how household characteristics influence lawn characteristics, as lawns play an important ecological role in human-dominated landscapes. This article investigates household and neighborhood socioeconomic characteristics as predictors of residential lawn-care expenditures and lawn greenness. The study area is the Gwynns Falls...

  11. Accessibility to primary health care in Belgium: an evaluation of policies awarding financial assistance in shortage areas

    Science.gov (United States)

    2013-01-01

    Background In many countries, financial assistance is awarded to physicians who settle in an area that is designated as a shortage area to prevent unequal accessibility to primary health care. Today, however, policy makers use fairly simple methods to define health care accessibility, with physician-to-population ratios (PPRs) within predefined administrative boundaries being overwhelmingly favoured. Our purpose is to verify whether these simple methods are accurate enough for adequately designating medical shortage areas and explore how these perform relative to more advanced GIS-based methods. Methods Using a geographical information system (GIS), we conduct a nation-wide study of accessibility to primary care physicians in Belgium using four different methods: PPR, distance to closest physician, cumulative opportunity, and floating catchment area (FCA) methods. Results The official method used by policy makers in Belgium (calculating PPR per physician zone) offers only a crude representation of health care accessibility, especially because large contiguous areas (physician zones) are considered. We found substantial differences in the number and spatial distribution of medical shortage areas when applying different methods. Conclusions The assessment of spatial health care accessibility and concomitant policy initiatives are affected by and dependent on the methodology used. The major disadvantage of PPR methods is its aggregated approach, masking subtle local variations. Some simple GIS methods overcome this issue, but have limitations in terms of conceptualisation of physician interaction and distance decay. Conceptually, the enhanced 2-step floating catchment area (E2SFCA) method, an advanced FCA method, was found to be most appropriate for supporting areal health care policies, since this method is able to calculate accessibility at a small scale (e.g. census tracts), takes interaction between physicians into account, and considers distance decay. While at

  12. Effects of Clown Doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

    Directory of Open Access Journals (Sweden)

    Patrícia Arriaga

    2016-04-01

    Full Text Available This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care. Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiety Inventory measured caregiver’s state anxiety. In addition, caregivers assessed the children’s functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children’s anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific paediatric hospital setting.

  13. [The patient blood management concept : Joint recommendation of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery].

    Science.gov (United States)

    Meybohm, P; Schmitz-Rixen, T; Steinbicker, A; Schwenk, W; Zacharowski, K

    2017-09-18

    Patient blood management is a multimodal concept that aims to detect, prevent and treat anemia, optimize hemostasis, minimize iatrogenic blood loss, and support a patient-centered decision to provide optimal use of allogeneic blood products. Although the World Health Organization (WHO) has already recommended patient blood management as a new standard in 2010, many hospitals have not implemented it at all or only in part in clinical practice. The German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery therefore demand that i) all professionals involved in the treatment should implement important aspects of patient blood management considering local conditions, and ii) the structural, administrative and budgetary conditions should be created in the health care system to implement more intensively many of the measures in Germany.

  14. Indoor air quality in Montréal area day-care centres, Canada.

    Science.gov (United States)

    St-Jean, Mélissa; St-Amand, Annie; Gilbert, Nicolas L; Soto, Julio C; Guay, Mireille; Davis, Karelyn; Gyorkos, Theresa W

    2012-10-01

    Indoor air quality (IAQ) has been understudied in day-care centres (DCCs), even though it can affect the respiratory health of children. This study was undertaken to assess IAQ in a randomly selected sample of 21 DCCs having space for at least 40 children in Montréal, Canada, and to determine associations between building characteristics and IAQ. Questionnaires on building characteristics and operation of the DCC were administered to managers. Temperature, relative humidity, and concentrations of carbon dioxide (CO(2)), formaldehyde and volatile organic compounds were measured in January and February 2008 in rooms attended by children aged between 18 and 60 months. Most DCCs (81%) had a mechanical ventilation system. Over 85% of the DCCs had a mean CO(2) concentration higher than 1000 ppm, the value generally targeted for comfort in buildings. Mean CO(2) concentrations were significantly lower in DCCs having a floor space meeting the provincial standards. The mean (standard deviation-SD) formaldehyde concentration was 22.9 (8.2) μg/m(3), with all participating DCCs being within Health Canada's Residential IAQ Guideline of 50 μg/m(3). The presence of a mechanical ventilation system and a large surface of play area per child were significantly associated with lower CO(2) levels, explaining 44% of the variance in indoor CO(2) concentrations. The presence of a mechanical ventilation system was also associated with significantly lower formaldehyde and acetaldehyde levels. Moreover, 68% of the variance in indoor acetaldehyde concentrations was explained by CO(2) levels, indicating that CO(2) was a better proxy of ventilation than the presence of a ventilation system, as this latter variable did not imply that the ventilation system was running or functioning adequately. These results demonstrate the need for on-going efforts to ensure sufficient floor space and adequate ventilation in DCCs to maintain good IAQ. Crown Copyright © 2012. Published by Elsevier Inc. All

  15. Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme.

    Science.gov (United States)

    Skinner, Henry; Skoyles, Julian; Redfearn, Sue; Jutley, Raj; Mitchell, Ian; Richens, David

    2013-01-01

    There are significant pressures on resident medical rotas on intensive care. We have evaluated the safety and feasibility of nurse practitioners (NPs) delivering first-line care on an intensive care unit with all doctors becoming non-resident. Previously, resident doctors on a 1:8 full-shift rota supported by NPs delivered first-line care to patients after cardiac surgery. Subsequently, junior doctors changed to a 1:5 non-resident rota and NPs onto a 1:7 full-shift rota provided first-line care. A single centre before-and-after service evaluation on cardiac intensive care. mortality rates, surgical trainee attendance in theatre and cost before and after the change. After-hour calls by NPs to doctors and subsequent actions were also audited after the change. The overall mortality rates in the 12 months before the change were 2.8 and 2.2% in the 12 months after (P = 0.43). The median [range] logistic EuroSCORE was 5.3 [0.9-84] before and 5.0 [0.9-85] after the change (P = 0.16). After accounting for the risk profile, the odds ratio for death after the change relative to before was 0.83, 95% confidence interval 0.41-1.69. Before the change, a surgical trainee attended theatre 467 of 702 (68%) cases. This increased to 539 of 677 (80%) cases after the change (P cardiac intensive care. Training opportunities for junior surgeons increased and costs were reduced.

  16. Study on Perioperative Care of Patients Treated With Circumcision Surgery%包皮手术患者的围手术期护理探析

    Institute of Scientific and Technical Information of China (English)

    马美艳

    2015-01-01

    Objective To explore perioperative care of patients treated with circumcision surgery.MethodsSelected 45 patients treated with circumcision surgery who are received and treated in hospital from November 2013 to December 2014 and divide them into two groups according to hospitalization sequence with 24 patients in study group and 21 patients in control group, patients in study group were given perioperative care, while patients in control group were given conventional care intervention, and then care effects of two groups was compared.ResultsPatients’ satisfaction rate, treatment efficacy and complication incidence in study group were much better than counterparts in control group, there is a differential between these two groups, and such a differential has statistic value (P<0.05). Conclusionperioperative care is of significance for patients treated with circumcision surgery, which is conducive to improving patients’ satisfaction with treatment, to increasing treatment efficacy and to decrease complication incidence.%目的:探讨包皮手术患者的围手术期护理探析。方法选取2013年11月~2014年12月我院接诊的45例包皮手术患者,按照入院的先后顺序分为24例实验组和21例对照组,实验组给予围手术期护理,对照组采用常规护理干预,观察两组患者的护理效果。结果实验组患者的护理满意度、治疗总有效率及并发症的发生率明显优于对照组,P<0.05,差异有统计学意义。结论包皮手术患者采用围手术期护理的效果显著,可以有效提高患者的满意度,提高治疗效果,降低并发症的发生率。

  17. International variations in availability and diffusion of alternatives to in-patient care in Europe : the case of day surgery

    NARCIS (Netherlands)

    Kroneman, Madelon W.; Westert, Gert P.; Groenewegen, Peter P.; Delnoij, Diane M.J.

    2001-01-01

    Objectives: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in healt

  18. International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery.

    NARCIS (Netherlands)

    Kroneman, M.W.; Westert, G.P.; Groenewegen, P.P.; Delnoij, D.M.J.

    2001-01-01

    Objectives: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in healt

  19. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der

    2015-01-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  20. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece

    Directory of Open Access Journals (Sweden)

    Konstantinos Giakoumidakis

    2014-01-01

    Conclusions: One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation.

  1. International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery.

    NARCIS (Netherlands)

    Kroneman, M.W.; Westert, G.P.; Groenewegen, P.P.; Delnoij, D.M.J.

    2001-01-01

    Objectives: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in

  2. Preventing the Complications of Cataract Surgery in Poor Areas%贫困地区白内障手术并发症的预防

    Institute of Scientific and Technical Information of China (English)

    赵俊宏; 王志成; 张兰英; 赵燕麟

    2002-01-01

    Objective To probe into the ways to prevent the complications of cataract surgery in poor areas in China. Methods141patients with catarat (163eyes) were divided into three groups. In group A, arc-cystectomy was adopt; In group B, opentin-cysteetomy: In group C, arc-cystectomy with minimal antibacterial drug added in irrigate liquid. Results The postoperative isionand rate of inplanted lens in group A are higher respectively than those in group B. Conclusion There are some characteristics ofcataract surgery in poor area. Arc-cystectomy lesseu the syndromes of the surgery. The minimal dose of tobramycin used in irrigateliquid is doable.%目的探讨贫困地区白内障手术中预防严重手术并发症的方法.方法将141例(163眼)病人随即分为三组,A组采用弧形截囊,B组开罐式截囊;C组弧形截囊,前房灌注液中加入微量妥布霉素;比较三组的术后效果.结果A组术后一周视力及人工晶状体植入率高于B组,术后一周角膜水肿率低于B组,差异均有显著性(P<0.05);A、C两组比较差异无显著性(P>0.05).结论贫困地区白内障手术有其特点,弧形截囊能减少手术并发症的发生,灌注液中加入妥布霉素是有效和可行的.

  3. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    Science.gov (United States)

    2010-11-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  4. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    Science.gov (United States)

    2011-09-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  5. [Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : Joint recommendation of the German Society of Anesthesiology and Intensive Care Medicine, the German Society of Surgery, and the German Society of Internal Medicine].

    Science.gov (United States)

    Zwissler, B

    2017-06-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e. g. blood chemistry, ECG, spirometry, chest x‑ray) can contribute to a reduction of perioperative risk is often not very well known or is controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective, noncardiothoracic surgery, which were initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and

  6. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

    Directory of Open Access Journals (Sweden)

    Niakas Dimitris

    2006-11-01

    Full Text Available Abstract Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426 residing in the broader Athens area (response rate 70.6%. Perceived health-related quality of life (HRQOL, as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a last-month visits to public sector physicians, b last-month visits to private sector physicians, c last-year visits to hospital emergency departments and d last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector. Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

  7. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Science.gov (United States)

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

    2017-01-31

    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Pin care

    Science.gov (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. www.aast.org/discharge-instructions-for-wound-cares . Accessed May 13, 2016.

  9. Fear and loathing in New England: examining the health-care perspectives of homeless people in rural areas.

    Science.gov (United States)

    Whitley, Rob

    2013-01-01

    Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: 'the rural homeless'. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status.

  10. Clinical nursing care of 79 gastric cancer patients with radical surgery%胃癌根治术79例临床护理

    Institute of Scientific and Technical Information of China (English)

    朱凯

    2011-01-01

    Objective: To explore the nursing methods for gastric cancer patients with radical surgery.Methods: 79 gastric cancer patients with radical surgery were given preoperative psychological care, nutritional support, effective coughing and deep breathing training; the preparation of the gastrointestinal tract was fully done; the close postoperative observation on the patient's condition, clearance of the air passage, gastrointestinal decompression and a reasonable diet were effectively carried ont and provided Results: The surgical results were satisfactory and no post - operative deaths.70 patients were cured and 9 patients got the control of disease, the average days of hospitalization were 16.9 days.Conclusion: The meticulous nursing care can increase the success rate of radical surgery and also lay a good foundation for the rehabilitation of the patients.%目的:探讨胃癌根治术患者的护理方法.方法:对79例胃癌根治术患者术前进行心理护理、营养支持、有效咳嗽和深呼吸的训练,做了充分的胃肠道准备,术后密切观察患者的病情变化,保持呼吸道畅通,进行有效的胃肠减压及合理饮食.结果:本组手术疗效满意,无手术后死亡.治愈出院70例,9例病情控制,平均住院16.9 d.结论:耐心细致地护理可提高胃癌根治术的成功率,同时也为患者的康复奠定了良好的基础.

  11. Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery.

    Science.gov (United States)

    Steffens, Nicole M; Tucholka, Jennifer L; Nabozny, Michael J; Schmick, Andrea E; Brasel, Karen J; Schwarze, Margaret L

    2016-10-01

    Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. To design an intervention to improve preoperative decision making and manage postoperative expectations. A Patient and Family Advisory Council (PFAC) was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Generation of a QPL to address patients' preoperative informational and decisional needs. Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The

  12. The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

    Directory of Open Access Journals (Sweden)

    Novikov Ilia

    2011-10-01

    Full Text Available Abstract Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. Methods/Design A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed. Discussion We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. Trial

  13. Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.

    Science.gov (United States)

    Bramesfeld, Anke; Pauletzki, Jürgen; Behrenz, Lars; Szecsenyi, Joachim; Willms, Gerald; Broge, Björn

    2015-08-01

    Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.

  14. Availability and quality of specialized ophthalmologic medical care: assessment by patients living in rural areas

    Directory of Open Access Journals (Sweden)

    S. V. Seraphimov

    2016-01-01

    Full Text Available The problem of restricted availability and quality of ophthalmologic medical care remains one of the main ones in the national healthcare. The article gives a comparative analysis of the opinions of rural residents of Leningrad region are in need of surgical treatment for ophthalmologic diseases, availability and quality of specialized medical care. A questionnaire was developed based on the methodology proposed by the Federal compulsory medical insurance Fund, through formal interviews of respondents of patients who received specialized ophthalmologic medical care in Leningrad region before opening of eye care hospitals for surgical treatment of cataract and glaucoma (148 patients and afterwards (320 patients. The results show that almost all patients who received treatment after the modernization of ophthalmologic offices are satisfied with the quality of medical care (completely satisfied – 91,3 %, quite satisfied – 7,6 %, which is significantly higher than the figures obtained in the survey of the patients before creation of specialized departments (t=3,6, p<0.05. Availability of medical care before reequipment of ophthalmologic departments in hospitals satisfied 62.8 % of respondents, and after the organization of activities of eye care hospitals – 75, 3 % (t=2,8, p<0.05. However, despite the new form of organization of medical aid, 27.5 % of the respondents are still not satisfied with its transport accessibility. Thus, patients receiving operative treatment of cataract are generally satisfied with the availability and quality of their medical services. Higher ratings of availability and quality of specialized eye medical care were received after opening of eye care hospitals for surgical treatment of cataract and glaucoma in Leningrad region.

  15. Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample.

    Science.gov (United States)

    Chappidi, Meera R; Kates, Max; Stimson, C J; Bivalacqua, Trinity J; Pierorazio, Phillip M

    2017-01-01

    We quantified the underestimation of hospital readmission rates that can occur with institutional databases and the incidence of care fragmentation among patients undergoing urological oncology procedures in a nationally representative database. The 2013 Nationwide Readmissions Database was queried for patients undergoing prostatectomy, cystectomy, nephroureterectomy, nephrectomy, partial nephrectomy and retroperitoneal lymph node dissection for urological malignancies. Nationally representative 30 and 90-day readmission and care fragmentation rates were calculated for all procedures. Readmission rates with and without nonindex hospital readmissions were compared with Pearson's chi-square test. Multivariable logistic regression models were used to identify predictors of care fragmentation at 90-day followup. For all surgical procedures readmission rates were consistently underestimated by 17% to 29% at 90-day followup. The rates of care fragmentation among readmitted patients were similar for all procedures, ranging from 24% to 34% at 90-day followup. Overall 1 in 4 readmitted patients would not be captured in institutional databases and 1 in 3 readmitted patients experienced care fragmentation. Multivariable models did not identify a predictor of care fragmentation that was consistent across all procedures. The high rate of underestimation of readmission rates across all urological oncology procedures highlights the importance of linking institutional and payer claims databases to provide more accurate estimates of perioperative outcomes and health care utilization. The high rate of care fragmentation across all procedures emphasizes the need for future efforts to understand the clinical relevance of care fragmentation in patients with urological malignancies, and to identify patients at risk along with potentially modifiable risk factors for care fragmentation. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier

  16. Accessing health care in a rural area: an evaluation of a voluntary medical transport scheme in the English Midlands.

    Science.gov (United States)

    Sherwood, K B; Lewis, G J

    2000-12-01

    In recent years notions of self-help and voluntarism have emerged as key elements in the delivery of services in rural England. This paper explores these themes by reference to 'Rural Wheels', a voluntary medical transport scheme in rural Northamptonshire, introduced to overcome the closure of branch surgeries and to provide access to a new medical centre. By focusing upon the organisation and operations of the scheme, the paper highlights the important role it plays in the welfare of rural residents, particularly elderly women. Yet, because effectively it is run by a small core group, the paper raises questions not just about the viability of this scheme but also about the increasing commitment of central government to the voluntary sector as a means of delivering health care to rural people.

  17. Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison study

    Directory of Open Access Journals (Sweden)

    Kuks Paul F

    2011-03-01

    Full Text Available Abstract Background Preventable adverse drug events (pADEs are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison study is initiated. Methods/Design A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care. The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-medical costs and indirect non-medical costs, extra costs per

  18. Development of a Virtual Reality Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery: Methodological Approach for a Randomized Controlled Trial.

    Science.gov (United States)

    Eijlers, Robin; Legerstee, Jeroen S; Dierckx, Bram; Staals, Lonneke M; Berghmans, Johan; van der Schroeff, Marc P; Wijnen, Rene Mh; Utens, Elisabeth Mwj

    2017-09-11

    Preoperative anxiety in children is highly prevalent and is associated with adverse outcomes. Existing psychosocial interventions to reduce preoperative anxiety are often aimed at distraction and are of limited efficacy. Gradual exposure is a far more effective way to reduce anxiety. Virtual reality (VR) provides a unique opportunity to gradually expose children to all aspects of the operating theater. The aims of our study are (1) to develop a virtual reality exposure (VRE) tool to prepare children psychologically for surgery; and (2) to examine the efficacy of the VRE tool in a randomized controlled trial (RCT), in which VRE will be compared to care as usual (CAU). The VRE tool is highly realistic and resembles the operating room environment accurately. With this tool, children will not only be able to explore the operating room environment, but also get accustomed to general anesthesia procedures. The PREoperative Virtual reality Intervention to Enhance Wellbeing (PREVIEW) study will be conducted. In this single-blinded RCT, 200 consecutive patients (aged 4 to 12 years) undergoing elective day care surgery for dental, oral, or ear-nose-throat problems, will be randomly allocated to the preoperative VRE intervention or CAU. The primary outcome is change in child state anxiety level between baseline and induction of anesthesia. Secondary outcome measures include child's postoperative anxiety, emergence delirium, postoperative pain, use of analgesics, health care use, and pre- and postoperative parental anxiety. The VRE tool has been developed. Participant recruitment began March 2017 and is expected to be completed by September 2018. To our knowledge, this is the first RCT evaluating the effect of a VRE tool to prepare children for surgery. The VRE intervention is expected to significantly diminish preoperative anxiety, postoperative pain, and the use of postoperative analgesics in pediatric patients. The tool could create a less stressful experience for both

  19. Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2014-02-01

    Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

  20. Utilization of Maternal Care Services in Urban area: Still an Issue of Modern World

    Directory of Open Access Journals (Sweden)

    Neha Bavarva, Prakash Patel, R K Bansal

    2015-01-01

    Conclusion: Though the overall rate of home delivery was less, most of the reasons cited for the home delivery are avoidable, especially when most mothers came into contact of health care system at least once."

  1. [Feasibility Study of a One-Day Educational Program to Train Advance Care Planning Facilitators(ACPFs)in Regional Areas].

    Science.gov (United States)

    Nishikawa, Mitsunori; Miura, Hisayuki; Oya, Sanae; Kato, Tomonari; Nagae, Hiroyuki; Osada, Yoshiyuki; Watanabe, Tetsuya; Matsuoka, Sachiko; Otsuka, Yasuro; Yamaguchi, Mie; Watanabe, Kazuko; Kito, Katsutoshi; Ooi, Hatsue; Suzuki, Naoko

    2016-12-01

    Promoting advance care planning in regional areas is important. Education For Implementing End-of-Life Discussion(EFIELD) is a two-day educational program for Advance Care Planning Facilitators(ACPFs)developed by the National Center for Geriatrics and Gerontology. Unfortunately, some trainers experience difficulties implementing the content of the program, and some trainees feel the program is too long for implementation in many regional areas. The purpose of the research is to clarify the feasibility of ACPFs education using a one-day program in regional areas. The methods involved documenting the process of a one-day program from implementation to evaluation from May of 2015 to March of 2016 and then evaluating the effectiveness of the program 3 months after the implementation using meeting minutes from 7 local hospitals. The results indicated a need for 5 steps from program implementation to evaluation as well as 5 categories for final evaluation. The most important finding is that E-FIELD challenged trainers to shorten and simplify their expressions in order to teach the content more efficiently. The second finding is that Group for Promoting Advance Care Planning & End Of Life Discussion in Chita(GACPEL) activities encouraged ACPimplementation within each hospital. The limitations of this research are related to small regional areas. In conclusion, a one-day regional ACPFs educational program is feasible.

  2. Primary health concept revisited: where do people seek health care in a rural area of Vietnam?

    Science.gov (United States)

    Khe, N D; Toan, N V; Xuan, L T T; Eriksson, B; Höjer, B; Diwan, V K

    2002-07-01

    The government of Vietnam is committed to promote and secure equity in access to health care for all citizens. The current rapid changes towards a market economy may challenge the government's wish for maintaining equity, especially for low income and vulnerable groups. The aim of this study was to investigate aspects of access and utilisation of health care of rural people. The study included a random sample of 1075 out of the 11,547 households in the Field Laboratory in Bavi district, northern Vietnam and a structured questionnaire was used. The results indicate that self-treatment is common practice and private providers are an important source of health services not only for those who are better off but also for poor households. The costs for health care are substantial for households, and lower income groups spent a significantly higher proportion of their income on health care than the rich did. The poor are deterred from seeking health care more often than the rich and for financial reason. As regards sources for payments, the poor relied much more on borrowing money to pay for their health care needs, while those who are better off relied mostly on household savings. A burden of high cost for treatment implies high risks for families to fall into a 'medical poverty trap'. Our findings suggest a need for developing risk-sharing schemes (co-payment, pre-payment and insurance), and appropriate allocation of scarce public resources. We suggest that the private health care sector needs both support and regulations to improve the quality and access to health care by the poor.

  3. Experience of the Checkerboard Area Health System in planning for rural health care.

    OpenAIRE

    1982-01-01

    The design of rural health care delivery systems often is based on concepts obtained from urban models. The implicit planning premises of successful urban models, however, may be inappropriate for many rural systems. An alternative model planned and implemented in the checkerboard region of rural northwest New Mexico has proved to be successful. This experience may be helpful to health care policymakers and planners confronted with environments that are not congruent with typical urban settin...

  4. Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

    OpenAIRE

    Fuster Torres, M. Angeles; Gargallo Albiol, Jordi; Berini Aytés, Leonardo; Gay Escoda, Cosme

    2008-01-01

    Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology...

  5. Rethinking the Well Woman Visit: A Scoping Review to Identify Eight Priority Areas for Well Woman Care in the Era of the Affordable Care Act.

    Science.gov (United States)

    Pascale, Alisa; Beal, Margaret W; Fitzgerald, Thérèse

    2016-01-01

    The annual pap smear for cervical cancer screening, once a mainstay of the well woman visit (WWV), is no longer recommended for most low-risk women. This change has led many women and their health care providers to wonder if they should abandon this annual preventive health visit altogether. Changing guidelines coinciding with expanded WWV coverage for millions of American women under the Patient Protection and Affordable Care Act have created confusion for health care consumers and care givers alike. Is there evidence to support continued routine preventive health visits for women and, if so, what would ideally constitute the WWV of today? A scoping review of the literature was undertaken to appraise the current state of evidence regarding a wide range of possible elements to identify priority areas for the WWV. A population health perspective taking into consideration the reproductive health needs of women as well as the preventable and modifiable leading causes of death and disability was used to identify eight domains for the WWV of today: 1) reproductive life planning and sexual health, 2) cardiovascular disease and stroke, 3) prevention, screening, and early detection of cancers, 4) unintended injury, 5) anxiety, depression, substance abuse, and suicidal intent, 6) intimate partner violence, assault, and homicide, 7) lower respiratory disease, and 8) arthritis and other musculoskeletal problems. The WWV remains a very important opportunity for prevention, health education, screening, and early detection and should not be abandoned. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  6. Early High-Volume Hemofiltration versus Standard Care for Post-Cardiac Surgery Shock. The HEROICS Study

    National Research Council Canada - National Science Library

    Combes, Alain; Bréchot, Nicolas; Amour, Julien; Cozic, Nathalie; Lebreton, Guillaume; Guidon, Catherine; Zogheib, Elie; Thiranos, Jean-Claude; Rigal, Jean-Christophe; Bastien, Olivier; Benhaoua, Hamina; Abry, Bernard; Ouattara, Alexandre; Trouillet, Jean-Louis; Mallet, Alain; Chastre, Jean; Leprince, Pascal; Luyt, Charles-Edouard

    2015-01-01

    ...), followed by standard-volume continuous venovenous hemodiafiltration (CVVHDF) until resolution of shock and recovery of renal function, or conservative standard care, with delayed CVVHDF only for persistent, severe acute kidney injury...

  7. Prophylactic aortic root surgery in patients with Marfan syndrome : 10 years' experience with a protocol based on body surface area

    NARCIS (Netherlands)

    Aalberts, Jan J. J.; van Tintelen, J. Peter; Hillege, Hans L.; Boonstra, Piet W.; van den Berg, Maarten P.; Waterbolk, T

    2008-01-01

    Background: Current guidelines recommending prophylactic aortic root replacement in Marfan syndrome are based on absolute diameters of the aortic root. However, aortic root diameter is a function of body surface area (BSA). Here, we report our experience with a protocol for prophylactic aortic root

  8. The application of geographic information systems (GIS) in identifying the priority areas for maternal care and services.

    Science.gov (United States)

    Salehi, Fatemeh; Ahmadian, Leila

    2017-07-12

    Improving maternal health is globally introduced as an important health priority. The purpose of this study is to identify the high priority areas which require more maternal health services in Kerman, Iran. This is a descriptive cross-sectional study, performed in 2015. The literatures were first explored in order to extract geographic indicators and sub indicators relevant to the maternal health. Data were collected by the use of a questionnaire designed on the basis of AHP (Analytic Hierarchy Process) method. The validity and reliability of the questionnaire were confirmed by three medical informatics experts and test-retest method, respectively. Data were analyzed by Expert Choice software in order to specify the weight and importance of each indicator. The information were then added to Geographic Information System (GIS) to analyze and create the related maps. Women's access to hospitals plays an important role in identifying high priority areas which need maternal care and services. More than half of the mothers in Kerman have a moderate level of access to maternal care services. There is an association between facilities that are provided for pregnant women and the existence of healthcare centers. Moreover, there is a negative correlation between maternal death and the number of facilities provided for medical care and services for pregnant women. The application of GIS provides us with the capability to identify high priority areas which need maternal care. According to current population policies in Iran and the probable increase in the fertility rate, it is wise to plan proper schedules to improve health care services for pregnant women in Kerman.

  9. Thyroid Surgery

    Science.gov (United States)

    ... Fax/Phone Home » Thyroid Surgery Leer en Español Thyroid Surgery GENERAL INFORMATION Your doctor may recommend that ... made in conjunction with your endocrinologist and surgeon. Thyroid Surgery FAQs QUESTIONS AND CONSIDERATIONS When thyroid surgery ...

  10. Plastic Surgery

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A A ... forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ...

  11. Multi-professional audit supports clinical governance in projecting and implementing a new stroke care area

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2013-03-01

    Full Text Available Patients with acute stroke have better outcomes in terms of survival or regaining independence if they receive organized inpatient care in a specific setting (Stroke Unit, SU where a coordinated multidisciplinary team can ensure the best level of care. The clinical governance of an SU requires a systematic monitoring of diagnostic, clinical and therapeutic processes through a structured audit. The entire project and set up of a new SU in Bentivoglio, Italy, were based on a model that focused on multidisciplinary teamwork and clinical governance. An audit based on the Benjamin audit cycle followed every step of the set up of the new SU. Markers from national and international guidelines and from the Italian Regional Audit, together with a specific database were used. The audit showed a high level of care and a significant improvement in the majority of clinical, diagnostic and therapeutic parameters. Only a few markers (i.e. waiting times for ultrasound tomography and prescription of oral anticoagulation therapy required specific projects in order to improve the results. Our experience confirmed that a structured audit can support clinical governance of an SU by monitoring clinical processes and quality of care. Such an audit involves the whole professional team and shows the effects of any single actions. It also helps integration and co-operation among staff. Furthermore, a structured audit is a useful instrument for professional accountability for both qualitative and quantitative aspects of care.

  12. Pain relief, spiritual needs, and family support: three central areas in intercultural palliative care.

    Science.gov (United States)

    Hanssen, Ingrid; Pedersen, Gry

    2013-12-01

    The purpose of this study was to draw out and coalesce the topic-specific information found in research literature regarding the provision of culturally sensitive palliative practice. This was a literature study and Gadamerian hermeneutic text analysis. It is more difficult to assess the level of pain in ethnic minority patients, and healthcare providers may become frustrated and interpret pain symptoms as fabrication. These patients are more likely to receive inadequate pain medication. Physical symptom management has become the priority in palliative care, but pain must also be viewed from the perspective of its social, cultural, and spiritual significance. Collectivist values may lead to an other-reliant and dependent coping style. This and religious demands may cause the family to rally around the patient. Many dying patients wish to be cared for at home by their families, but as the patient often has complex needs, the family may not be able to cope with the patient's care. Formal education and in-service programs are needed for healthcare providers, together with empirical studies regarding how to achieve more culturally appropriate care in intercultural palliative practice. The immigrant population needs to be educated about cancer and the various kinds of palliative and hospice care offered in the society in which they now live.

  13. The scope of plastic surgery

    African Journals Online (AJOL)

    2013-08-03

    Aug 3, 2013 ... areas of surgery (especially general surgery), plastic surgeons are arguably the .... Who do you feel are experts in laparoscopic surgery? e (general surgeons) a. Maxillofacial .... of pressure sore. ORIF = open reduction internal fixation. ... Plastic versus cosmetic surgery: What's the difference? Plast Reconstr.

  14. Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province

    Science.gov (United States)

    2010-01-01

    Background Asbestos related diseases include a number of conditions due to inhalation of asbestos fibres at work, at home or in the environment, such as pleural mesothelioma, asbestosis and calcified pleural plaques. Few epidemiological studies have established the incidence of asbestos related diseases in our area. The present proposal is based on a retrospective study externally funded in 2005 that is currently taking place in the same area and largely carried out by the same research team. The aim of the study is to achieve a comprehensive and coordinated detection of all new cases of Asbestos Related Diseases presenting to primary care practitioners. Methods/design This is a multicentre, multidisciplinary and pluri-institutional prospective study. Setting 12 municipalities in the Barcelona province within the catchment area of the health facilities that participate in the study. Sample This is a population based study, of all patients presenting with diseases caused by asbestos in the study area. Measurements A clinical and epidemiological questionnaire will be filled in by the trained researchers after interviewing the patients and examining their clinical reports. Discussion Data on the incidence of the different Asbestos Related Diseases in this area will be obtained and the most plausible exposure source and space-time-patient profile will be described. The study will also improve the standardization of patient management, the coordination between health care institutions and the development of preventive activities related with asbestos exposure and disease. PMID:20412567

  15. Leadership in cardiac surgery.

    Science.gov (United States)

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance.

  16. [Service robots in elderly care. Possible application areas and current state of developments].

    Science.gov (United States)

    Graf, B; Heyer, T; Klein, B; Wallhoff, F

    2013-08-01

    The term "Service robotics" describes semi- or fully autonomous technical systems able to perform services useful to the well-being of humans. Service robots have the potential to support and disburden both persons in need of care as well as nursing care staff. In addition, they can be used in prevention and rehabilitation in order to reduce or avoid the need for help. Products currently available to support people in domestic environments are mainly cleaning or remote-controlled communication robots. Examples of current research activities are the (further) development of mobile robots as advanced communication assistants or the development of (semi) autonomous manipulation aids and multifunctional household assistants. Transport robots are commonly used in many hospitals. In nursing care facilities, the first evaluations have already been made. So-called emotional robots are now sold as products and can be used for therapeutic, occupational, or entertainment activities.

  17. KinoHaptics: An Automated, Wearable, Haptic Assisted, Physio-therapeutic System for Post-surgery Rehabilitation and Self-care.

    Science.gov (United States)

    Rajanna, Vijay; Vo, Patrick; Barth, Jerry; Mjelde, Matthew; Grey, Trevor; Oduola, Cassandra; Hammond, Tracy

    2016-03-01

    A carefully planned, structured, and supervised physiotherapy program, following a surgery, is crucial for the successful diagnosis of physical injuries. Nearly 50 % of the surgeries fail due to unsupervised, and erroneous physiotherapy. The demand for a physiotherapist for an extended period is expensive to afford, and sometimes inaccessible. Researchers have tried to leverage the advancements in wearable sensors and motion tracking by building affordable, automated, physio-therapeutic systems that direct a physiotherapy session by providing audio-visual feedback on patient's performance. There are many aspects of automated physiotherapy program which are yet to be addressed by the existing systems: a wide classification of patients' physiological conditions to be diagnosed, multiple demographics of the patients (blind, deaf, etc.), and the need to pursue patients to adopt the system for an extended period for self-care. In our research, we have tried to address these aspects by building a health behavior change support system called KinoHaptics, for post-surgery rehabilitation. KinoHaptics is an automated, wearable, haptic assisted, physio-therapeutic system that can be used by a wide variety of demographics and for various physiological conditions of the patients. The system provides rich and accurate vibro-haptic feedback that can be felt by the user, irrespective of the physiological limitations. KinoHaptics is built to ensure that no injuries are induced during the rehabilitation period. The persuasive nature of the system allows for personal goal-setting, progress tracking, and most importantly life-style compatibility. The system was evaluated under laboratory conditions, involving 14 users. Results show that KinoHaptics is highly convenient to use, and the vibro-haptic feedback is intuitive, accurate, and has shown to prevent accidental injuries. Also, results show that KinoHaptics is persuasive in nature as it supports behavior change and habit building

  18. [Health care personnel's opinion on the breast-feeding pattern in the Mexican rural area].

    Science.gov (United States)

    Potter, J E; Mojarro Dávila, O; Hernández, D

    1991-01-01

    This paper surveys the health care personnel's knowledge and opinion about the physiology of the mother milk production and the issues that occur when it is stopped at an earlier moment. From an inquire carried out in 1984 on 155 doctors and nurses and 48 midwives that render their services to the rural population of Mexico, it was found that the majority of the health care personnel recognized breast-feeding as the best nurture for the child. Nevertheless, this personnel is against having a long breast-feeding period. More than half of the doctors and nurses commented that the breast-feeding period must be stopped when the child has diarrhea, which is contrary to the international health agencies opinion. The majority of the health care personnel recommends the introduction of complementary food to children under three months old and suggests a quick stop of the breast-feeding period. From these data it is shown that the health care personnel has little knowledge about the breast-feeding role as an element that increases the period of amenorrhea and its value as a natural contraceptive. The relation between breast-feeding and amenorrhea and infertility is inaccurate, that is why it is concluded that it is necessary to have training for the health care personnel in some physiological aspects of breast-feeding that are of prime importance. If the health care personnel has a better knowledge about breast-feeding, these influencing agents to decrease the incidence and value of breast-feeding will turn into strong promoters of such a healthy practice.

  19. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  20. Towards a functional topography of sensory gating areas: invasive P50 recording and electrical stimulation mapping in epilepsy surgery candidates.

    Science.gov (United States)

    Kurthen, Martin; Trautner, Peter; Rosburg, Timm; Grunwald, Thomas; Dietl, Thomas; Kühn, Kai-Uwe; Schaller, Carlo; Elger, Christian E; Urbach, Horst; Elisevich, Kost; Boutros, Nash N

    2007-07-15

    The filtering of sensory information, also referred to as "sensory gating", is impaired in various neuropsychiatric diseases. In the auditory domain, sensory gating is investigated mainly as a response decrease of the auditory evoked potential component P50 from one click to the second in a double-click paradigm. In order to relate deficient sensory gating to anatomy, it is essential to identify the cortical structures involved in the generation of P50. However, the exact cerebral topography of P50 gating remains largely unknown. In a group of 17 patients with drug-resistant focal epilepsy, P50 was recorded invasively via subdural electrodes, and the topography of functionally indispensable ("eloquent") cortices was obtained by electrical stimulation mapping. These eloquent areas were involved in language, motor, and sensory functions. P50 could be identified in 13 patients in either temporal (n=8) or midfrontal sites (n=5). There were six occurrences (in five patients) of overlap of sites with maximal P50 responses and eloquent areas. Those were auditory (n=1), supplementary sensorimotor (n=3), primary motor (n=1), and supplementary negative motor (n=1). Results suggest that the early stage of sensory gating already involves a top-down modulation of sensory input by frontal areas.

  1. Patient Views on Three Key Service Areas within Hospital COPD Care

    Science.gov (United States)

    Roberts, C. Michael; Seiger, Anil; Ingham, Jane

    2009-01-01

    Objective: The views of patients with Chronic Obstructive Pulmonary Disease (COPD) about three key services (non-invasive ventilation [NIV], early discharge schemes and rehabilitation) were sought in order to inform recommendations for the delivery of optimum care within a national programme of hospital COPD service development. Design: Four focus…

  2. Access to health care in relation to socioeconomic status in the Amazonian area of Peru

    DEFF Research Database (Denmark)

    Kristiansson, Charlotte; Gotuzzo, Eduardo; Rodriguez, Hugo

    2009-01-01

    ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drug...... be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.......ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs...... in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers), and medication for their children in relation to reported symptoms and socio-economic status. Self...

  3. Family caregivers' assessments of caring for a relative with dementia: a comparison of urban and rural areas.

    Science.gov (United States)

    Ehrlich, Kethy; Boström, Anne-Marie; Mazaheri, Monir; Heikkilä, Kristiina; Emami, Azita

    2015-03-01

    This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors. Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas. A cross-sectional study design was used. A total of 102 caregivers (response rate 85%) from urban (n=57) and rural (n=46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models. Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales. The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas. To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out. © 2014 John Wiley & Sons Ltd.

  4. Effect of Intravenous Acetaminophen on Post-Anesthesia Care Unit Length of Stay, Opioid Consumption, Pain, and Analgesic Drug Costs After Ambulatory Surgery

    Science.gov (United States)

    Khobrani, Moteb A.; Camamo, James M.; Patanwala, Asad E.

    2017-01-01

    Objectives The primary objective was to assess whether the use of intravenous acetaminophen (APAP) in the ambulatory surgery setting is associated with a decreased length of stay in the post-anesthesia care unit (PACU). The secondary outcomes evaluated were pain scores, opioid consumption, and total cost of analgesics used in the PACU. Methods This was a retrospective cohort study conducted in adult patients (18 years of age or older) who received an eye, ear, nose, or throat (EENT) procedure at an outpatient surgery center between January 2014 and January 2015. Patients were consecutively included until the desired sample was reached during two six-month time periods: 1) intravenous APAP available on the formulary (APAP group) and 2) intravenous APAP not available on the formulary (non-APAP group). Results The cohort included 174 patients who received an EENT procedure (87 patients in the APAP group and 87 patients in the non-APAP group). The median PACU length of stay was 66 minutes (interquartile range [IQR], 48–92) in the APAP group and 71 minutes (IQR, 52–89) in the non-APAP group (P = 0.269). Mean pain score categories in the APAP versus non-APAP group were mild (85% versus 53%, respectively; P < 0.001), moderate (13% versus 33%, respectively; P = 0.002), and severe (2% versus 14%, respectively; P = 0.005). The median opioid consumption in morphine equivalents was 9 mg (IQR, 5–13) in the APAP group and 8 mg (IQR, 5–12) in the non-APAP group (P = 0.081). The total cost of analgesics used in the PACU was significantly greater in the APAP group ($15 versus $1; P < 0.001). Conclusions Intravenous APAP use in EENT ambulatory surgery is not associated with decreased PACU length of stay. However, it may decrease postoperative pain following EENT procedures. PMID:28163558

  5. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  6. Integrated bariatric surgery residency

    Directory of Open Access Journals (Sweden)

    Eltorai AE

    2014-11-01

    Full Text Available Adam EM Eltorai Warren Alpert Medical School of Brown University, RI, USA Abstract: Obesity is a major public health concern. Given its lasting efficacy for improving obesity and obesity-related diseases, bariatric surgery is an increasingly common treatment option. As the implementation of the Affordable Care Act progresses, the impending physician shortage will become more severe. Thus there will be an even greater need for doctors specialized in the management and treatment of obese patients. The development of integrated bariatric surgery residency programs could be considered and is discussed herein. Keywords: obesity, bariatric surgery, integrated residency, surgery education

  7. Integration of a hospital information system in a Greek cardiac surgery hospital through specific education programs for health care personnel: development of nursing documentation.

    Science.gov (United States)

    Tsirintani, M

    1995-01-01

    This study represents an educative effort for integrating an innovative Hospital Information System (HIS) in Greece for quality impact on nursing practice and conductive research. The Hospital involved is the Onassis Cardiac Surgery Center (OCSC), a new 150 bedded state-of-the-art hospital in Athens. The aims of this study are the following: 1) To present the educational assessment concerning the HIS of Onassis Center, 2) To develop Nursing documentation to support the educational needs of nurses and clerks in correlation with the Nursing/Medical record of HIS, and 3) To show the meaning of continuing education for new and old hospital staff and the use of the system as an educative and consultative tool for decision support for health care personnel, especially nurses.

  8. Timing of surgery for sciatica

    NARCIS (Netherlands)

    Peul, Wilco C.

    2008-01-01

    The frequently diagnosed lumbar disc herniation can disappear by natural course, but still leads to high low back surgery rates. The optimal period of conservative care, before surgery is executed, was unknown. It is surprising that scientific evidence was lacking which justified “early” surgery. Su

  9. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    OpenAIRE

    Aleksic Dejan; Bukonjic Andriana; Stefanovic Srdjan

    2015-01-01

    The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  10. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    Directory of Open Access Journals (Sweden)

    Aleksic Dejan

    2015-09-01

    Full Text Available The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  11. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili;

    2012-01-01

    Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care ...

  12. Factors associated with patient satisfaction in surgery: the role of patients' perceptions of received care, visit characteristics, and demographic variables.

    Science.gov (United States)

    Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim

    2010-11-01

    Measures of satisfaction of surgical patients can be used to evaluate and redesign the process of care or to complement established procedures to improve quality of services. However, study findings regarding aspects of patient satisfaction are often inconsistent and depend on the setting. The primary goals of this research were to identify factors associated with satisfaction among patients in a surgical setting. Data used in this study were obtained from randomly selected 2699 surgical patients discharged during January-December 2008 from 26 hospitals who responded to a mailed survey. The instrument assessed satisfaction regarding 23 items of perceived care, patient demographic, and visit characteristics. Bivariate and multivariate techniques were used to reveal relations between indicators and overall satisfaction. Bivariate statistics showed strong relations between overall satisfaction and perceived care with weaker findings pertaining to demographic and visit characteristics. The Multivariate logistic regression predicting overall satisfaction demonstrated that patients receiving surgical services predominantly have similar demands and priorities regardless of age and gender. The strongest factors were (P < 0.05) the interpersonal manner of medical practitioners and nurses, organization of operations, admittance, and discharge, as well as perceived length of stay. This study identified factors that are related to satisfaction of surgical patients and indicated the intensity of this relationship. These findings support health care providers and medical practitioners with valuable information to meet needs and preferences of patients receiving surgical services. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. The content and development trend of acute care surgery in America and its enlightenment to the training of acute care surgeons in China%美国急诊外科的内涵和发展趋势及对我国创伤救治医师培养的启示

    Institute of Scientific and Technical Information of China (English)

    宗兆文

    2015-01-01

    Acute care surgery are both a emergency surgical care system and a training paradigm developed by American trauma care society.Its development is very helpful in improving the trauma care ability and efficiency in U.S.A.The training curriculum includes elective general surgery, emergency surgery, trauma surgery and surgi-cal critical care.Part of neurological surgery, orthopedics and interventional radiology skills are also included. These successful experiences are worth learning by the trauma care society in China.%美国急诊外科是其创伤学界为应对创伤医师短缺而创建的外科急症救治模式和培训模式,对提高美国的创伤救治水平和效率具有重要的积极意义。其课程设置包括选择性普通外科、急症普通外科、创伤外科和外科重症监护,同时还选择性加入部分神经外科、骨科和介入性放射学技能的培训。美国急诊外科的成功经验值得我国创伤学界借鉴。

  14. Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?

    Science.gov (United States)

    Batsis, John A; Pletcher, Sarah N; Stahl, James E

    2017-01-05

    The growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity. We describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models. Recommendations to extend the benefit's coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

  15. Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

    DEFF Research Database (Denmark)

    Bisgaard, Jannie; Gilsaa, Torben; Rønholm, Ebbe;

    2013-01-01

    clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ...... dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1...... or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P ...

  16. History of Cardiothoracic Surgery at Columbia University: A Century at the Vanguard of Clinical Care, Education, and Innovation.

    Science.gov (United States)

    Argenziano, Michael; Smith, Craig R; Spotnitz, Henry M; Steinglass, Kenneth M; Bacha, Emile

    2016-01-01

    The Columbia University Cardiothoracic Surgery Program dates back to the earliest days of the specialty itself, when the first pioneers ventured into the chest, and eventually the heart, to treat diseases previously believed to be beyond the reach of medicine. This spirit of innovation, creativity, and vision has grown over the ensuing century and has driven the development of advances that have defined the specialty and saved countless lives. From novel techniques for the repair of complex congenital cardiac defects and acquired cardiovascular diseases, to comprehensive management of lung and esophageal maladies, and to the marvel of minimally invasive and percutaneous interventions, the march of progress has never been stronger, more dramatic, or more consequential that it is at Columbia today. Fueled by people who -- as descendants of those early pioneers -- have been raised in the "Columbia culture," the commitment to innovation and education has never been greater. Copyright © 2016. Published by Elsevier Inc.

  17. Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems.

    Science.gov (United States)

    Oladipo, Jimoh Ayanda

    2014-06-01

    Disparities in use of healthcare services between rural and urban areas have been empirically attributed to several factors. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. The objectives determine the relative importance of the various predisposing, enabling, need and health services factors on utilization of health services; similarity between rural and urban areas; and major explanatory variables for utilization. A four-stage model of service utilization was constructed with 31 variables under appropriate model components. Data is collected using cross-sectional sample survey of 1086 potential health services consumers in selected health facilities and resident milieu via questionnaire. Data is analyzed using factor analysis and cross tabulation. The 4-stage model is validated for the aggregate data and data for the rural areas with 3-stage model for urban areas. The order of importance of the factors is need, enabling, predisposing and health services. 11 variables are found to be powerful predictors of utilization. Planning of different categories of health care facilities in different locations should be based on utilization rates while proper management of established facilities should aim to improve health seeking behavior of people.

  18. Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

    Directory of Open Access Journals (Sweden)

    Duan Song

    2011-01-01

    Full Text Available Abstract Background The Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV under the acquired immunodeficiency syndrome (AIDS care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART under the national Free Care Program (China CARES. Methods A retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV treatment year. Results Five ARV regimens are commonly used in China CARES: zidovudine (AZT + lamivudine (3TC + nevirapine (NVP, stavudine (D4T + 3TC + efavirenz (EFV, D4T + 3TC + NVP, didanosine (DDI + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY among 276 participants. The total costs for treating all adverse drug events (ADEs and opportunistic infections (OIs were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus P = 0.02; and ≥200 cells/μL versus P P P = 0.04 and OIs (P = 0.02 were significantly

  19. Mortality after surgery in Europe

    DEFF Research Database (Denmark)

    Pearse, Rupert M; Moreno, Rui P; Bauer, Peter

    2012-01-01

    Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international...... study designed to assess outcomes after non-cardiac surgery in Europe....

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

    Directory of Open Access Journals (Sweden)

    Giselle Domingues Sanches

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A obesidade é considerada uma epidemia e afeta mais de 300 milhões de pessoas no mundo. A sua prevalência vem aumentando significativamente nos últimos anos e a mortalidade do paciente obeso crítico, em alguns estudos, mostra-se maior, especialmente em pacientes cirúrgicos que necessitam de UTI. Este estudo teve como objetivo ressaltar as particularidades das condutas em Medicina Intensiva no pós-operatório do paciente obeso submetido à cirurgia bariátrica. CONTEÚDO: A taxa dos pacientes obesos na UTI é de 9% a 26% e o aumento no número de cirurgias bariá­tricas tem elevado o fluxo de obesos internados em UTI. A obesidade tem várias particularidades fisiopatológicas que devem ser conhecidas para melhor manuseio pós-operatório. Entre elas estão as restrições pulmonares, que leva ao aumento do número de complicações, o fator de risco para síndrome coronariana aguda eventos trombóticos. CONCLUSÕES: O número de pacientes submetidos à cirurgia bariátrica está aumentando, o que leva a maior número de pacientes obesos internados na UTI. As alterações fisiológicas da obesidade, juntamente com as complicações de um paciente crítico, são desafios para a prática médica. Portanto, é relevante conhecer a fisiopatologia da obesidade, o tratamento rotineiro das complicações no pós-operatório de cirurgia bariátrica.BACKGROUND AND OBJECTIVES: Obesity is an epidemic disease reaching more than 300 million people all over the world. Its prevalence has increased during the past few years and according to some studies its mortality in the critically ill patient seems to be much higher, especially among patients who were submitted to surgery. This study has as objective to discuss some particularities of managing obese patients in the intensive care unit after bariatric surgery. CONTENTS: The rate of obese patient in the ICU ranges from 9% to 26% and the increase in the number of bariatric

  1. iGuide to plastic surgery: iPhone apps, the plastic surgeon, and the health care environment.

    Science.gov (United States)

    Mohan, Anita Tanniru; Branford, Olivier Alexandre

    2012-07-01

    The growth in the adoption of smartphones among clinicians has been phenomenal. The demand for medical applications, or "apps," downloaded by smartphone users has led to the development of practical and educational apps for clinicians, medical students, and patients. In addition to being a valuable resource for the clinician, mobile technologies are revolutionizing the nature and delivery of health care services. This article summarizes the current trends in the smartphone market and explores the medical apps that are currently available.

  2. Increasing the value of time reduces the lost economic opportunity of caring for surgeries of longer-than-average times.

    Science.gov (United States)

    Abouleish, Amr E; Prough, Donald S; Whitten, Charles W; Conlay, Lydia A

    2004-06-01

    Anesthesiology groups that provide care for surgical procedures of longer-than-average duration are economically disadvantaged by both increased staffing costs and reduced revenue. Under the current billing system, anesthesia time is valued the same regardless of the total case duration. In this study, we evaluated the effect on four academic anesthesiology departments of two hypothetical scenarios by changing the anesthesia care billing system to make more valuable either 1) all time units or 2) just second-hour and subsequent time units. From the four departments, case-specific data (anesthesia Current Procedural Terminology code and minutes of care) were collected for all anesthesia cases billed for 1 yr. Basic units were determined from the American Society of Anesthesiologists (ASA) relative value guide. The average time for each case was defined as the average anesthesia time for that specific Current Procedural Terminology code, as published by the Center for Medicare and Medicaid Services (CMS). The actual total ASA units per hour (tASA/h) was determined by adding all the basic units and time units and dividing by hours of anesthesia care (minutes of anesthesia care divided by 60). We then calculated a hypothetical CMS tASA/h for each group by substituting the CMS average time for each anesthesia procedure time for the actual time reported by each group and using 15-min time units. For each group, the Actual (Act) tASA/h and CMS tASA/h were calculated for both options-changing the interval for all time units or only for second and subsequent hours. Intervals were 15, 12, 10, 7, 6, or 5 min. When changing all time units, Act tASA/h and CMS tASA/h were never equal for all groups. The two productivity measures became approximately equal if only time units after the first hour were changed to 6- to 7-min intervals. When changes were applied only to the Act tASA/h (with CMS tASA/h remaining at 15-min intervals), at the 12-min interval either option resulted in a

  3. Human Trafficking in Areas of Conflict: Health Care Professionals' Duty to Act.

    Science.gov (United States)

    Bloem, Christina; Morris, Rikki E; Chisolm-Straker, Makini

    2017-01-01

    Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked.

  4. [Geographical distribution of medical expenditure for the aged insured by National Health Insurance in secondary medical care areas in Japan].

    Science.gov (United States)

    Zhang, T; Tanihara, S; Yanagawa, H

    1998-06-01

    To determine what factors affect medical expenditure for the aged insured by the National Health Insurance among secondary medical care areas. The original data of municipalities were combined and converted into the data of secondary medical areas. The original data included medical expenditure of the aged in 1994, medical supply factors per 100,000 population (numbers of doctors, numbers of general beds in hospitals, numbers of clinics, etc.) and socio-economic factors (income, proportion of employees for three sectors of industries, population density, average size of family, etc.). Medical expenditures for inpatients and outpatients were used separately as independent variables. The medical supply and socio-economic factors have been used as dependent variables. Multiple regression models were applied to clarify the differences in the contributing factors between inpatient and outpatient. 1. The maximum inpatient and outpatient medical expenditures for the aged are respectively 4 times and 2.6 times more expensive than minimum expenditures among secondary medical care areas. 2. The numbers of beds, income per capita, numbers of doctor, average size of family, proportion of employees for third level industry and income accounted for 57.4% of variance in inpatient medical expenditure of the aged. 3. The proportion of employees for first level industry, the numbers of beds and average members of family accounted for 21.4% of variance in outpatient medical expenditure of the aged. 4. Medical expenditure for inpatients related with medical supply and socioeconomic factors differently from that of outpatients.

  5. Lagophthalmos surgery in leprosy: findings from a population-based survey in Korea.

    Science.gov (United States)

    Courtright, P; Kim, S H; Tungpakorn, N; Cho, B H; Lim, Y K; Lee, H J; Lewallen, S

    2001-09-01

    Lagophthalmos continues to be a serious problem in cured leprosy patients. We conducted a population-based survey of lagophthalmos surgical coverage (LSC), barriers to lagophthalmos surgery and outcome of lagophthalmos surgery in leprosy patients in South Korea. In our survey, there were 60 patients with lagophthalmos who had needed surgery (> 5 mm gap), 34 of whom had received surgery, resulting in a lagophthalmos surgery coverage of 57%. Among the 34 patients who had received lagophthalmos surgery, 18 needed further surgery. Among those who had never had surgery, none of the demographic indicators predicted surgical uptake; the primary reason given for failure to have surgery was lack of knowledge about it. Outcome of surgery (by eye) showed that 29% of eyes still had a gap of 5 mm or more. The frequency of symptoms (tearing, blurring of vision, pain, etc.) was high. Even in settings with a good eye care infrastructure, such as Korea, uptake of surgery can still be low and results may not be satisfactory to patients. There is a need for practical guidelines for leprosy control programmes in the areas of (a) patient recognition, (b) patient education, (c) monitoring the uptake of surgery, and (d) monitoring the outcome of surgery to ensure the best possible outcome.

  6. The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

    Directory of Open Access Journals (Sweden)

    Chen Chi-Liang

    2008-03-01

    Full Text Available Abstract Background Taiwan's National Health Insurance (NHI, implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in

  7. Cataract Surgery: Fraud, Waste, and Abuse. A Report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    This report is a summary of the findings from the Subcommittee on Health and Long-Term Care of the United States House of Representatives Select Committee on Aging investigation of cataract surgery and the use of intraocular lenses (IOL's) in the United States. The document provides background on the definition and treatment of cataracts and…

  8. Access to Maternal Health Care Services in the Cape Coast Metropolitan Area, Ghana

    Directory of Open Access Journals (Sweden)

    D. Adei

    2012-02-01

    Full Text Available Maternal mortality can be prevented if mothers had routine obstetric care and access to emergency obstetric services. However, in accessing healthcare most expecting mothers will have to struggle with distance and financial problems. The study sought to; assess the barriers that discourage women from accessing antenatal, delivery and postnatal services in the Cape coast Metropolis and give recommendations to inform policy. Questionnaire was administered to 150 pregnant women and nursing mothers with babies less than one year from ten communities in the Cape Coast Metropolis. An institutional questionnaire was administered at the University of Cape Coast Hospital which provides health care services to the communities. The study revealed that challenges such as money (16.7%, distance (15.4%, and the behaviour of health personnel (20% were the dominant barriers to accessing antenatal, delivery and post natal services in the Cape Cost Metropolis. These barriers lead to the inability of 14% of pregnant women and nursing mothers with babies less than one year to adhere to the minimum antenatal visitation number of 5 recommended by the Royal College of Obstetricians and Gynaecologists. Again 15.3% of these respondents were delivered by Traditional Birth Attendants and family members, whiles 5.8% were unable to adhere to the minimum postnatal visitation of two times. NGO’s and government organizations for women should organize training programmes aimed at improving the livelihood or employment for women in these communities.

  9. Psychological evaluation of patients after breast cancer surgery and care strategies improvement%乳腺癌术后患者心理状态评估及干预策略改进

    Institute of Scientific and Technical Information of China (English)

    Yanjun Zhang; Caigang Liu; Feng Jin

    2011-01-01

    Objective: The aim of the study was to investigate the level of self-image of patients after breast cancer surgery, and explore factors influencing self-image among patients who have experienced different types of surgeries, and set out a foundation for the improvement of care strategies. Methods: The 538 patients with primary breast cancer who underwent surgery in the Department of Breast Surgery, First Hospital of China Medical University, Shenyang, China, from January 2004 to January 2009 were included in the study. The psychological status of the patients was evaluated by body image after breast cancer questionnaire (BIBCQ), social support rating scale (SSRS), self-rating anxiety scale (SRAS), depression rat-ing scale (DRS), and general information questionnaire. The factors influencing the self-image were selected by a stepwise regression analysis. Results: The patients who underwent breast-conserving surgery were the most satisfied with their body image, followed by those underwent surgery of modified radical mastectomy with reconstruction. However, cases treated by modified radical mastectomy without reconstruction had negative outcomes. Regardless of operation type, the self-image was influenced by anxiety, level of abuse by husband, and sexual satisfaction after operation. Conclusion: The self-image of patients who underwent different breast cancer surgeries was influenced by different factors, and individualized nursing should be offered in accordance with the specific situation.

  10. Contemporary oral and maxillofacial surgery.

    Science.gov (United States)

    Pavel, F; Machado, L

    1994-04-01

    This article provides a panoramic view of the nine major areas of subspecialty in the field of oral and maxillofacial surgery: facial trauma, surgical pathology, dentoalveolar surgery, rehabilitation of the cleft lip/palate patient, temporomandibular joint surgery, preprosthetic and implant rehabilitation, surgical management of obstructive sleep apnea, correction of jaw deformities and cosmetic+ surgery. Clinical cases are used to illustrate the most recent advances in each of these nine areas.

  11. Mass conflict and care in war affected areas. In search of assessment and psychosocial intervention

    NARCIS (Netherlands)

    de Jong, K.T.

    2014-01-01

    Research in this thesis is focused on the relevance of psychosocial programs in areas of mass violence. Central questions are: how to assess needs in terms of psychosocial health, how to best address those needs, and what is the effectiveness of these mental health interventions? Our findings in Che

  12. Mass conflict and care in war affected areas. In search of assessment and psychosocial intervention

    NARCIS (Netherlands)

    de Jong, K.T.

    2014-01-01

    Research in this thesis is focused on the relevance of psychosocial programs in areas of mass violence. Central questions are: how to assess needs in terms of psychosocial health, how to best address those needs, and what is the effectiveness of these mental health interventions? Our findings in Che

  13. Master's level in primary health care education - students' and preceptors' perceptions and experiences of the alteration in the clinical areas.

    Science.gov (United States)

    Löfmark, Anna; Mamhidir, Anna-Greta

    2010-06-16

    Many Western European countries are undergoing reforms with changes in higher education according to the Bologna declaration for Higher European Education Area. In accordance with these changes, the Master's degree was introduced in specialist nurse education in Sweden in 2007, and as a result changed the curriculum and modified theoretical and clinical areas. The aim of this study was to investigate students' and preceptors' perceptions and experiences of Master's level education in primary health care with a focus on the clinical area. A descriptive design and qualitative approach was used. Interviews with ten students and ten preceptors were performed twice, before and after the clinical practice period. Interviews were audio-recorded, transcribed verbatim and themes formulated. Students perceived alteration in the content of the education at the Master's level such as more independence and additional assignments. The preceptors perceived benefits with the Master's level but were unsure of how to transform theoretical and abstract knowledge into practice. Writing the Master's thesis was seen by students to take time away from clinical practice. For some students and preceptors the content of the Master's level clinical practice area was experienced as vague and indistinct. The students had not expected supervision to be different from earlier experiences, while preceptors felt higher demands and requested more knowledge. Both students and preceptors perceived that education at the Master's level might lead to a higher status for the nurses' profession in primary health care. Students and preceptors experienced both advantages and disadvantages concerning the change in specialist nurse education in primary health care at the Master's level. The altered educational content was experienced as a step forward, but they also questioned how the new knowledge could be used in practice. The relevance of the Master's thesis was questioned. Supervision was seen by students

  14. An exploratory study of services marketing in global markets: major areas of inquiry for the health care services industry.

    Science.gov (United States)

    Young, S; Erdem, S A

    1996-01-01

    It has been stated that one of the major challenges for the international marketer is the design of an efficient strategy for marketing services to international markets. This paper reviews some of the issues associated with services marketing in global markets along with the basic variables of service industries. An exploratory assessment of the health care services industry results in a list composed of several inquiry areas which should be examined by multinational companies. It is hoped that the review of the issues raised in this paper provides a basis for decision making and further research.

  15. Lung surgery

    Science.gov (United States)

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  16. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  17. Cataract Surgery

    Science.gov (United States)

    ... and Videos: What Do Cataracts Look Like? Cataract Surgery Written By: Kierstan Boyd Reviewed By: Elena M ... how they work. What to expect with cataract surgery Before surgery: Your ophthalmologist will measure your eye ...

  18. Nanotechnology and regenerative therapeutics in plastic surgery: The next frontier.

    Science.gov (United States)

    Tan, Aaron; Chawla, Reema; G, Natasha; Mahdibeiraghdar, Sara; Jeyaraj, Rebecca; Rajadas, Jayakumar; Hamblin, Michael R; Seifalian, Alexander M

    2016-01-01

    The rapid ascent of nanotechnology and regenerative therapeutics as applied to medicine and surgery has seen an exponential rise in the scale of research generated in this field. This is evidenced not only by the sheer volume of papers dedicated to nanotechnology but also in a large number of new journals dedicated to nanotechnology and regenerative therapeutics specifically to medicine and surgery. Aspects of nanotechnology that have already brought benefits to these areas include advanced drug delivery platforms, molecular imaging and materials engineering for surgical implants. Particular areas of interest include nerve regeneration, burns and wound care, artificial skin with nanoelectronic sensors and head and neck surgery. This study presents a review of nanotechnology and regenerative therapeutics, with focus on its applications and implications in plastic surgery.

  19. Nanotechnology and regenerative therapeutics in plastic surgery: The next frontier

    Science.gov (United States)

    Tan, Aaron; Chawla, Reema; Natasha, G; Mahdibeiraghdar, Sara; Jeyaraj, Rebecca; Rajadas, Jayakumar; Hamblin, Michael R.; Seifalian, Alexander M.

    2015-01-01

    Summary The rapid ascent of nanotechnology and regenerative therapeutics as applied to medicine and surgery has seen an exponential rise in the scale of research generated in this field. This is evidenced not only by the sheer volume of papers dedicated to nanotechnology but also in a large number of new journals dedicated to nanotechnology and regenerative therapeutics specifically to medicine and surgery. Aspects of nanotechnology that have already brought benefits to these areas include advanced drug delivery platforms, molecular imaging and materials engineering for surgical implants. Particular areas of interest include nerve regeneration, burns and wound care, artificial skin with nanoelectronic sensors and head and neck surgery. This study presents a review of nanotechnology and regenerative therapeutics, with focus on its applications and implications in plastic surgery. PMID:26422652

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

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

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

  1. Risk Factors Associated with Very Low Birth Weight in a Large Urban Area, Stratified by Adequacy of Prenatal Care.

    Science.gov (United States)

    Xaverius, Pamela; Alman, Cameron; Holtz, Lori; Yarber, Laura

    2016-03-01

    This study examined risk and protective factors associated with very low birth weight (VLBW) for babies born to women receiving adequate or inadequate prenatal care. Birth records from St. Louis City and County from 2000 to 2009 were used (n = 152,590). Data was categorized across risk factors and stratified by adequacy of prenatal care (PNC). Multivariate logistic regression and population attributable risk (PAR) was used to explore risk factors for VLBW infants. Women receiving inadequate prenatal care had a higher prevalence of delivering a VLBW infant than those receiving adequate PNC (4.11 vs. 1.44 %, p inadequate PNC regarding Black race (36.4 vs. 79.0 %, p inadequate PNC. Among women with inadequate PNC, Medicaid was protective against (aOR 0.671, 95 % CI 0.563-0.803; PAR -32.6 %) and smoking a risk factor for (aOR 1.23, 95 % CI 1.01, 1.49; PAR 40.1 %) VLBW. When prematurity was added to the adjusted models, the largest PAR shifts to education (44.3 %) among women with inadequate PNC. Community actions around broader issues of racism and social determinants of health are needed to prevent VLBW in a large urban area.

  2. What Is Elective Surgery? (For Parents)

    Science.gov (United States)

    ... Surgery How to Find Affordable Health Care Financial Management During Crisis Anesthesia Basics Preparing Your Child for Anesthesia Word! Surgery ... Have Surgery? Health Care: What Do You Know? Anesthesia Basics Contact ... Visit the Nemours Web site. Note: All information on KidsHealth® is for educational purposes only. For ...

  3. Impaired postural stability after laparoscopic surgery

    DEFF Research Database (Denmark)

    Eskildsen, K Z; Staehr-Rye, A K; Rasmussen, L S;

    2015-01-01

    BACKGROUND: Early postoperative mobilisation may reduce patient morbidity and improve hospital efficiency by accelerated discharge. The aim of this study was to measure postural stability early after laparoscopic surgery in order to assess how early it is safe to mobilise and discharge patients....... METHODS: We included 25 women undergoing outpatient gynaecological laparoscopic surgery in the study. Patients received standardised anaesthesia with propofol, remifentanil and rocuronium. Postural stability was assessed preoperatively, at 30 min after tracheal extubation, and at discharge from the post...... postoperatively. No significant changes were found for sway velocity. We found no significant changes in mean sway, sway area or sway velocity at discharge from the post-anaesthesia care unit approximately 2 h after surgery. CONCLUSION: Postural stability was significantly impaired 30 min after outpatient...

  4. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... to Be Smart About Social Media Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  5. Integrated model of primary and secondary eye care for underserved rural areas: the L V Prasad Eye Institute experience.

    Science.gov (United States)

    Rao, Gullapalli N; Khanna, Rohit C; Athota, Sashi Mohan; Rajshekar, Varda; Rani, Padmaja Kumari

    2012-01-01

    Blindness is a major global public health problem and recent estimates from World Health Organization (WHO) showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS) provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP). It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI) developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion) in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

  6. Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

    Directory of Open Access Journals (Sweden)

    Gullapalli N Rao

    2012-01-01

    Full Text Available Blindness is a major global public health problem and recent estimates from World Health Organization (WHO showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP. It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

  7. Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan.

    Science.gov (United States)

    Nishimura, Katsuji; Yokoyama, Kanako; Yamauchi, Noriko; Koizumi, Masako; Harasawa, Nozomi; Yasuda, Taeko; Mimura, Chizuru; Igita, Hazuki; Suzuki, Eriko; Uchiide, Yoko; Seino, Yusuke; Nomura, Minoru; Yamazaki, Kenji; Ishigooka, Jun

    2016-01-01

    To compare the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium. These tools have not been tested in a specialized cardio-surgical ICU. Sensitivities and specificities of each tool were assessed in a cardio-surgical ICU in Japan by two trained nurses independently. Results were compared with delirium diagnosed by psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. There were 110 daily, paired assessments in 31 patients. The CAM-ICU showed 38% sensitivity and 100% specificity for both nurses. All 20 false-negative cases resulted from high scores in the auditory attention screening in CAM-ICU. The ICDSC showed 97% and 94% sensitivity, and 97% and 91% specificity for the two nurses (cutoff ≥4). In a Japanese cardio-surgical ICU, the ICDSC had a higher sensitivity than the CAM-ICU. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Analgesia and sedation after pediatric cardiac surgery.

    Science.gov (United States)

    Wolf, Andrew R; Jackman, Lara

    2011-05-01

    In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric intensive care unit (PICU). This reflects perceived priorities of the primary disease process over the supporting structure of PICU, with a generic approach to sedation and analgesia that can result in additional morbidities and delayed recovery. Management of the marginal patient requires optimisation of not only cardiac and other attendant pathophysiology, but also every aspect of supportive care. Individualized sedation and analgesia strategies, starting in the operating theater and continuing through to hospital discharge, need to be regarded as an important aspect of perioperative care, to speed the process of recovery. © 2010 Blackwell Publishing Ltd.

  9. Health and health care of mothers and children in a suburban area of Luanda, Angola.

    Science.gov (United States)

    Humbwavali, João Baptista; Giugliani, Camila; Duncan, Bruce Bartholow; Harzheim, Erno; Lavor, Antônio Carlile Holanda; Lavor, Míria Campos; Barbosa, Maria Idalice; Thomas, Patrícia Barros; Hauser, Lisiane

    2014-06-01

    Population health data available in Angola are often insufficient to guide the planning of health interventions. To address this gap, the goal of the present study was to investigate the health of mothers and infants in a suburban municipality in Luanda (Cacuaco), in order to provide a baseline for future comparisons. This was a prevalence study investigating infants younger than 2 years of age and their mothers. Mothers were interviewed, and children's height and weight were measured. Of 749 mothers interviewed, 98.5% (95% CI 98.2-99.1%) had at least one prenatal visit and 51.7% (95% CI 47.4-56.3%) had a health card. Most mothers with a health card had their first prenatal visit before the 20th week of pregnancy, and had at least four prenatal visits; 81.1% (95% CI 78.3-84.1%) of mothers also had their child's health card. Prevalence of exclusive breastfeeding at 6 months was 19% (95% CI 16.2-23.1%). Prevalence of low height-for-age and low BMI-for-age were 32 and 6%, respectively. Mothers with higher education levels were more likely to have had their first prenatal visit earlier, to have had more prenatal visits, to have given birth at a health facility, and to have her own and her child's health cards. Results showed a high prevalence of prenatal care and a low frequency of acute malnutrition. Maternal education level, among factors studied, was the predominant correlate of more positive health behaviors. These findings suggest important progress of mother and child health in Cacuaco, and may serve as a baseline for the planning of health interventions.

  10. Sustainable primary health care services in rural and remote areas: innovation and evidence.

    Science.gov (United States)

    Wakerman, John; Humphreys, John S

    2011-06-01

    To highlight how evidence from studies of innovative rural and remote models of service provision can inform global health system reform in order to develop appropriate, accessible and sustainable primary health care (PHC) services to 'difficult-to-service' communities. The paper synthesises evidence from remote and rural PHC health service innovations in Australia. There is a strong history of PHC innovation in Australia. Successful health service models are 'contextualised' to address diverse conditions. They also require systemic solutions, which address a range of interlinked factors such as governance, leadership and management, adequate funding, infrastructure, service linkages and workforce. An effective systemic approach relies on alignment of changes at the health service level with those in the external policy environment. Ideally, every level of government or health authority needs to agree on policy and funding arrangements for optimal service development. A systematic approach in addressing these health system requirements is also important. Service providers, funders and consumers need to know what type and level of services they can reasonably expect in different community contexts, but there are gaps in agreed indicators and benchmarks for PHC services. In order to be able to comprehensively monitor and evaluate services, as well as benchmarks, we need adequate national information systems. Despite the gaps in our knowledge, we do have a significant amount of information about what works, where and why. At a time of global PHC reform, applying this knowledge will contribute significantly to the development of appropriate, sustainable PHC services and improving access. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  11. Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery.

    Science.gov (United States)

    Rubinger, Luc; Chan, Carol; Andrade, Danielle; Go, Cristina; Smith, Mary Lou; Snead, O Carter; Rutka, James T; Widjaja, Elysa

    2016-02-01

    The aims of this study were to evaluate the influence of socioeconomic status (SES) on time-to-surgery (TTS) and surgical outcome in children with treatment-resistant epilepsy in a universal health care system. The cohort consisted of children who had undergone resective epilepsy surgery between 2001 and 2013 in Canada. The patients' postal codes were linked to Statistics Canada National Household Survey data to obtain dissemination area income, which was used to infer SES. Time-to-surgery was defined as the interval from date of epilepsy onset to date of surgery. Seizure outcome was classified using ILAE classification. The associations between SES and TTS, as well as SES and surgical outcome, were assessed. Two hundred eighty-four children who had epilepsy surgery were included. Patients in the lowest income quintile had a significantly higher TTS relative to the highest income quintile (β=0.121, p=0.044). There were no significant associations between income quintiles and seizure-free surgical outcome (odds ratio (OR)=0.746-1.494, all p>0.05). However, patients in the lowest income quintile had a significantly lower odds of an improvement in seizure frequency relative to the highest income quintile (OR=0.262, p=0.046). The TTS was not uniform across SES in spite of the existence of a universal health care system. This finding highlights the need to address social and economic barriers for epilepsy surgery to improve access to this potentially curative treatment. Those with lower SES had lower likelihood of improvement in seizure control following epilepsy surgery and may require additional support including social and financial support to mitigate the discrepancies in seizure control following surgery between SES levels.

  12. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

  13. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  14. Management of blunt splenic injuries Retrospective cohort study of early experiences in an Acute Care Surgery Service recently established.

    Science.gov (United States)

    Occhionorelli, Savino; Morganti, Lucia; Andreotti, Dario; Cappellari, Lorenzo; Stano, Rocco; Portinari, Mattia; Vasquez, Giorgio

    2015-01-01

    Il trattamento conservativo dei trauma splenici è ormai il “gold standard” per i bassi gradi di lesione splenica (III grado), mentre è ancora dibattuta la gestione dei traumi splenici severi (IV-V grado). Controversa rimane la gestione dei traumi splenici di III grado, che potrebbero beneficiare del trattamento conservativo, associato o meno ad angioembolizzazione dell’arteria splenica, in centri specializzati ed idonei alla gestione conservativa dei traumi degli organi parenchimatosi. Le ultime linee guida pubblicate dalla “Eastern Association of Surgery of Trauma” risalgono al 2012 e provvedono a dare solo delle raccomandazioni di livello II-III sulla gestioni dei traumi splenici. Il fattore che maggiormente influenza il successo del trattamento conservativo è la selezione dei pazienti che potrebbero beneficiare di tale gestione. Alla luce di ciò, l’obiettivo primario del nostro studio è di identificare i pazienti con lesioni spleniche post-traumatiche, che dovrebbero essere sottoposti a trattamento conservativo; l’obiettivo secondario è di confrontare il decorso clinico e la durata della degenza nei pazienti trattati conservativamente e in quelli sottoposti a splenectomia. Tutti i pazienti con trauma splenico, ricoverati presso l’U.O. di Chirurgia d’Urgenza dell’Azienda Ospedaliera- Universitaria Sant’Anna, Ferrara (Italia) tra Novembre 2010 (anno in cui è stata istituita l’U.O.) e Dicembre 2014, sono stati inclusi nello studio, per un totale di 54 pazienti. Di questi 54 pazienti, 29 (53.7%) sono stati immediatamente sottoposti ad intervento chirurgico di laparotomia esplorativa e splenectomia, mentre 25 (46.3%) sono stati sottoposti a trattamento conservativo. I pazienti sottoposti ad angioembolizzazione sono stati 9 su 25 (36%). Sono stati raccolti dati epidemiologici, dati riguardanti il decorso clinico e le indagini laboratoristiche e radiologiche a cui i pazienti sono stati sottoposti al momento dell’accesso in Pronto

  15. Monitored anaesthesia care – Comparison of nalbuphine/dexmedetomidine versus nalbuphine/propofol for middle ear surgeries: A double-blind randomised trial

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao Nallam

    2017-01-01

    Full Text Available Background and Aims: Middle ear surgeries (MESs are usually performed under sedation with local anaesthesia and can be well tolerated by the patient with minimal discomfort. In the present study, we compare the effect of nalbuphine/dexmedetomidine combination with nalbuphine/propofol on sedation and analgesia in monitored anaesthesia care. Methods: One hundred adult patients undergoing MESs under monitored anaesthesia care (MAC were randomly allocated into two groups. All patients in both groups received injection nalbuphine 50 μg/kg intravenously (IV. Group D received a bolus dose of injection dexmedetomidine 1 μg/kg IV over 10 min followed by an infusion started at 0.4 μg/kg/h IV. Group P received a bolus dose of injection propofol 0.75 mg/kg followed by an infusion started at 0.025 mg/kg/min IV. Sedation was titrated to Ramsay Sedation Score (RSS of 3. Patient's mean arterial pressure, heart rate, saturation peripheral pulse and need for intraoperative rescue sedation/analgesia were recorded and compared. The data analysis was carried out with Z test and Chi-square test. Results: Mean RSS was significantly more in Group D (4.24 ± 1.54 as compared to Group P (2.58 ± 0.95. Overall VAS score was also significantly less in Group D (3.5 ± 1.7 than in Group P (5.4 ± 1.8. In total, 16 patients (32% in Group D had hypotension whereas 7 patients (14% only in Group P had hypotension. Conclusion: Nalbuphine/dexmedetomidine combination is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing MESs under MAC. Better surgeon and patient satisfaction were observed with nalbuphine/dexmedetomidine. Haemodynamics need to be closely monitored.

  16. Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

    Energy Technology Data Exchange (ETDEWEB)

    Jardim, Thiago Veiga, E-mail: thiagoveiga@cardiol.br; Sousa, Ana Luiza Lima [Liga de Hipertensão Arterial - Universidade Federal de Goiás, Goiânia, GO (Brazil); Povoa, Thais Rolim [Faculdade de Educação Física - Universidade Estadual de Goiás, Goiânia, GO (Brazil); Barroso, Weimar Sebba; Chinem, Brunela; Jardim, Paulo Cesar Veiga [Liga de Hipertensão Arterial - Universidade Federal de Goiás, Goiânia, GO (Brazil)

    2014-12-15

    Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs. To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05). In general, there was an unfavorable progression of CVRFs in the

  17. Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

    Directory of Open Access Journals (Sweden)

    Thiago Veiga Jardim

    2014-12-01

    Full Text Available Background: Cardiovascular diseases (CVDs are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs in young adults and their modification over time are measures that change the risks and prevent CVDs. Objectives: To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. Methods: All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH, diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. Results: The first stage of the study included 281 individuals (91% of all the students, of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample, of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men, followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05. Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05. Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05 were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05. Finally, nutritionists showed an increase in dyslipidemia (p < 0.05. Conclusion

  18. Enhanced recovery after vascular surgery: protocol for a systematic review

    Directory of Open Access Journals (Sweden)

    Gotlib Conn Lesley

    2012-11-01

    Full Text Available Abstract Background The enhanced recovery after surgery (ERAS programme is a multimodal evidence-based approach to surgical care which begins in the preoperative setting and extends through to patient discharge in the postoperative period. The primary components of ERAS include the introduction of preoperative patient education; reduction in perioperative use of nasogastric tubes and drains; the use of multimodal analgesia; goal-directed fluid management; early removal of Foley catheter; early mobilization, and early oral nutrition. The ERAS approach has gradually evolved to become the standard of care in colorectal surgery and is presently being used in other specialty areas such as vascular surgery. Currently there is little evidence available for the implementation of ERAS in this field. We plan to conduct a systematic review of this literature with a view to incorporating ERAS principles into the management of major elective vascular surgery procedures. Methods We will search EMBASE (OVID, 1947 to June 2012, Medline (OVID, 1948 to June 2012, and Cochrane Central Register of Controlled Trials (Wiley, Issue 1, 2012. Searches will be performed with no year or language restrictions. For inclusion, studies must look at adult patients over 18 years. Major elective vascular surgery includes carotid, bypass, aneurysm and amputation procedures. Studies must have evaluated usual care against an ERAS intervention in the preoperative, perioperative or postoperative period of care. Primary outcome measures are length of stay, decreased complication rate, and patient satisfaction or expectations. Only randomized controlled trials will be included. Discussion Most ERAS approaches have been considered in the context of colorectal surgery. Given the increasing use of multiple yet different aspects of this pathway in vascular surgery, it is timely to systematically review the evidence for their independent or combined outcomes, with a view to implementing

  19. Establishment of wound care center and development of burns and plastic surgery discipline%伤口治疗中心建立与烧伤整形学科发展

    Institute of Scientific and Technical Information of China (English)

    刘毅

    2011-01-01

    @@ 伴随着我国社会经济的高速发展,人民生活水平日益提高,生活习惯和饮食习惯逐渐发生变化,由此也导致疾病谱出现相应改变.以糖尿病为例,我国糖尿病发病率呈逐年增高的趋势.%To study the interaction between establishment of wound care center and development of discipline of burns and plastic surgery. The changes in number of outpatient,time for dressing change per patient, outpatient service income,number of inpatients and operations in our hospital were summarized and retrospectively analyzed before and after establishment of wound care center. The proportion of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients in the same term were investigated. Meanwhile, the development of discipline of burns and plastic surgery before and after establishment of wound care center was analyzed. Compared with those in the year before establishment of wound care center, outpatient number, time for dressing change per patient,outpatient service income, inpatient number, and amount of operations were all increased(with increase rate of 330% , 569%,325%, 161% , and 173%, respectively) in the year after establishment of wound care center. The ratio of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients was respectively increased from 4.3% and 4.5% in the year before establishment of wound care center to 9.2% and 12.4% in the year after establishment of wound care center. Patient satisfaction, bed utilization rate, levels of wound treatment and repair were all improved after establishment of wound care center. So we come to conclusions as follows. Establishment of wound care center can promote development of the standard of burns and plastic surgery. Comprehensive use of multidisciplinary theories and techniques concerning burns, plastic and aesthetic surgery, medical aesthetics, etc. can be beneficial for improvement of quality of wound

  20. Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system.

    Science.gov (United States)

    Waibel, Sina; Vargas, Ingrid; Aller, Marta-Beatriz; Coderch, Jordi; Farré, Joan; Vázquez, M Luisa

    2016-09-02

    The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system. A descriptive-interpretative qualitative study was conducted using a phenomenological approach. A two-stage theoretical sample was selected: (i) the study contexts: healthcare areas in Catalonia with different services management models; (ii) users ≥ 18 years of age who were attended to at both care levels for the same health problem. Data were collected by means of individual semi-structured interviews with patients (n = 49). All interviews were recorded and transcribed. A thematic content analysis was conducted segmented by study area, with a mixed generation of categories and triangulation of analysts. Patients in all three areas generally perceived that continuity of clinical management across levels existed, on referring to consistent care (same diagnosis and treatment by doctors of both care levels, no incompatibilities of prescribed medications, referrals across levels when needed) and accessibility across levels (timeliness of appointments). In terms of continuity of information, patients in most areas mentioned the existence of information sharing via computer and its adequate usage. Only a few discontinuity elements were reported such as long waiting times for specific tests performed in secondary care or insufficient use of electronic medical records by locum doctors. Different factors influencing continuity were identified by

  1. Neglect of a Neglected Disease in Italy: The Challenge of Access-to-Care for Chagas Disease in Bergamo Area.

    Directory of Open Access Journals (Sweden)

    Ernestina Carla Repetto

    2015-09-01

    Full Text Available Chagas disease (CD represents a growing problem in Europe; Italy is one of the most affected countries but there is no national framework for CD and access-to-care is challenging. In 2012 Médecins Sans Frontières (MSF started an intervention in Bergamo province, where many people of Latin American origin (PLAO are resident. A new model-of-care for CD, initiated by Centre for Tropical Diseases of Sacro Cuore Hospital, Negrar (CTD, the NGO OIKOS and the Bolivian community since 2009 in the same area, was endorsed. Hereby, we aim to describe the prevalence of CD and the treatment management outcomes among PLAO screened from 1st June 2012 to 30th June 2013.Retrospective cohort study using routine program data. Screening sessions were done in Bergamo at OIKOS outpatient service and serological confirmation, staging and treatment for CD was offered at the CTD. MSF provided health education on CD, awareness generation prior to screening days, pre-test and post-test counselling through cultural mediators of Latin American origin.Of 1305 PLAO screened, 223(17% had CD. Among 210 patients eligible for treatment, 102(49% were lost-to-follow-up before treatment. The median delay from diagnosis to treatment was 4 months (range 0.7-16.6 months. Among 108 started on treatment, 63(58% completed treatment, 36(33% interrupted treatment, (33 for drug side-effects, two for patients decision and one due to pregnancy, 6(6% were lost-to-follow-up and 3(3% were on treatment at study censuring.In this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care. There is an urgent need to involve affected communities and local regional health authorities to take part to this model-of-care, adapting it to the local epidemiology. The Italian health authorities should take steps in advocating for a change in the current paradigm.

  2. Planning for Your Child's Surgery (Osteogenesis Imperfecta)

    Science.gov (United States)

    ... Blue Jeans for Better Bones Calendar Online Store Planning for Your Child's Surgery: What Parents Need to ... but the entire family as well. Before Surgery: Planning Become well informed. Taking care of your child ...

  3. Weight-loss surgery and children

    Science.gov (United States)

    ... more likely to have problems such as: Low self-esteem Poor grades in school Depression ... weight-loss surgery should receive care at an adolescent bariatric surgery center. There, a team of experts ...

  4. Syphilis screening among 27,150 pregnant women in South Chinese rural areas using point-of-care tests.

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    Li-Gang Yang

    Full Text Available OBJECTIVES: To determine the prevalence and correlates of syphilis among pregnant women in rural areas of South China. METHODS: Point-of-care syphilis testing was provided at 71 health facilities in less developed, rural areas of Guangdong Province. Positive samples were confirmed at a local referral center by toluidine red unheated serum tests (TRUST and Treponema pallidum particle agglutination (TPPA tests. RESULTS: Altogether 27,150 pregnant women in rural Guangdong were screened for syphilis. 106 (0.39% syphilis cases were diagnosed, of which 78 (73.6% received treatment for syphilis. Multivariate analysis revealed that older pregnant women (31-35 years old, aOR 2.7, 95% CI 0.99-7.32; older than 35 years old, aOR 5.9, 95% CI 2.13-16.34 and those with a history of adverse pregnant outcomes (aOR 3.64, 95% CI 2.30-5.76 were more likely to be infected with syphilis. CONCLUSIONS: A high prevalence of syphilis exists among pregnant women living in rural areas of South China. Enhanced integration of syphilis screening with other routine women's health services (OB GYN, family planning may be useful for controlling China's syphilis epidemic.

  5. The Safety and Efficacy of Dexmedetomidine versus Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

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    Wenming Wang

    2016-11-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA and monitored anesthesia care (MAC can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery. Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n=67, DEX infusion at 0.5 μg·kg–1 for 10 min, Group D2 (n=75, DEX infusion at 1 μg·kg–1 for 10 min, and Group S (n=73, sufentanil infusion 0.3 μg·kg–1 for 10 min. Ramsay sedation scale (RSS of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36±4.23 vs. 13.42±2.12 vs. 15.98±4.58 min, respectively, for D1, D2, S; P<0.001. More patients in groups D1 and S required rescue midazolam to achieve RSS=3 (74.63% vs. 42.67% vs. 71.23%, respectively, for D1, D2, S; P<0.001. However, the total dose of rescue midazolam was significantly higher in group D1 (2.8±0.3 vs. 1.9±0.3 vs. 2.0±0.4 mg, respectively, for D1, D2, S; P<0.001. The time to first dose of rescue midazolam was significantly longer in group D2 (17.32±4.47 vs. 23.56±5.36 vs. 16.55±4.91 min, respectively, for D1, D2, S; P<0.001. Significantly fewer

  6. [A randomized controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: hospital stay and health care costs].

    Science.gov (United States)

    Manzanares Campillo, María Del Carmen; Martín Fernández, Jesús; Amo Salas, Mariano; Casanova Rituerto, Daniel

    2016-12-09

    The use of enteral formulas with immunonutrients in patients with gastrointestinal malignancies susceptible to surgery can reduce postoperative morbidity, at the expense of reduced infectious complications, with the consequent reduction in hospital stay and health care costs. Prospective randomized study. 84 patients operated on a scheduled basis for resectable colorectal cancer were recruited. In the group YES IN Impact © Oral was administered for 8 days (3 sachets a day), compared with the NOT IN group who did not receive it. 40.5% (17) patients without immunonutrition suffered infectious complications vs. 33.3% (14) of YES IN. In patients with rectal cancer NOT IN, 50% (8) suffered minor infectious complications (p=.028). In each group (YES IN, NOT IN, colon and rectal cancer) when infectious complications were observed, the variables total hospital stay and costs doubled, with significant differences. These variables showed higher values in the group NOT IN compared with those who received immunonutrition, although these differences were not statistically significant. NOT IN patients suffered infectious complications more frequently than YES IN, with significant results in the subgroup of patients with rectal cancer. The total hospital stay and costs were slightly higher in the group not supplemented, doubling in each category significantly (YES IN, NOT IN, colon and rectal cancer), when infectious complications were observed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  7. Estimate of Bariatric Surgery Numbers, 2011-2015

    Science.gov (United States)

    ... to Care Toolkit EHB Access Toolkit Estimate of Bariatric Surgery Numbers, 2011-2015 Published July 2016 2011 2012 ... Online Education Directory Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  8. Improving the outcomes in gastric cancer surgery.

    Science.gov (United States)

    Tegels, Juul J W; De Maat, Michiel F G; Hulsewé, Karel W E; Hoofwijk, Anton G M; Stoot, Jan H M B

    2014-10-14

    Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and five-year survival rates are poor, therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately, in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-, intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index (e.g., Charlson comorbidity index), assessment of nutritional status (e.g., short nutritional assessment questionnaire, nutritional risk screening - 2002) and frailty assessment (Groningen frailty indicator, Edmonton frail scale, Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential. Implementation of fast-track or enhanced recovery after surgery programs is showing promising results, although future studies have to determine what the exact optimal strategy is. Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection. Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far. Advances in postoperative care include optimal timing of oral diet, which has been shown to reduce hospital stay. In general, hospital volume, i.e., centralization, and clinical audits might further improve the outcome in gastric cancer surgery. In conclusion, progress has been made in improving the surgical treatment of gastric cancer. However, gastric cancer treatment is high risk surgery and many areas for future research remain.

  9. An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related influencing factors

    Institute of Scientific and Technical Information of China (English)

    Ju-Ying Luo; Ling-Lin Kong; Zhi-Xia Zhang; Yan-Sheng Ye; Cui-Yu Bao; Li-Juan Tu; Ya-Zhen Yang

    2016-01-01

    Objective: To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables. Methods: A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities. Results: The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and 100.25 ± 22.56, respectively. Both of these scores significantly differed by age, education level, marital status, and income (P Conclusions: Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities. The self-care capabilities of the elderly can be enhanced by improving their health value using the“knowing-trusting-acting”model.

  10. Occupational risk of HIV infection among western health care professionals posted in AIDS endemic areas.

    Science.gov (United States)

    de Graaf, R; Houweling, H; van Zessen, G

    1998-08-01

    In this study on occupational risks of HIV infection among 99 Dutch medics working in AIDS endemic areas, 61% reported percutaneous exposures during an average stay of 21 months. The mean number of injuries was lower among physicians (2.0 versus 3.9 per year) and higher among nurses (1.9 versus 1.2) than in previous research conducted in 1987-1990 among Dutch medics returning from Africa. But the reduction of exposures among physicians might be explained by the fact that the number of procedures they carried out was less in the later study. Also among nurses a shift of tasks was seen. On the basis of an estimated HIV prevalence in the patient population of 19%, a chance of transmission per accident of 0.3%, and 1.9 percutaneous exposures per year, the mean occupational risk of HIV infection per year can be estimated at 0.11% per person. Besides length of stay and number of activities, characteristics of the work setting were associated with the frequency of different kinds of injuries. From the analysis of 109 extensive descriptions of recent accidents, it appeared that the majority of the injuries occurred during routine activities and were self-inflicted. Injuries with hollow needles usually occurred after the actual medical act (e.g. during recapping). Carelessness (e.g. due to fatigue) or being in a hurry (e.g. because of an emergency) were also often the cause of percutaneous injuries, as were the poor quality of the equipment, lack of professional skills, or a combination of these factors. Prevention activities are still important to reduce the frequency of occupational exposures. But they will not eliminate them totally; from the descriptions of recent exposures it was clear that some of the injuries occurred in spite of precautions.

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  12. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  13. Epidemiological study on Buccal Health in the 12 years old population of Health Care Area VIII in Cienfuegos.

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    Yumaidi Colina Sánchez

    2007-08-01

    Full Text Available Background: The 12 years-old children population is worldwide taken as a reference age to compare the buccal health condition of different countries, by means of various indicators that measure the presence of the main buccal diseases. The knowledge of these epidemiological profiles generates information to guide the services planning policies of the Primary Health Care. Objective: To characterize 12 years-old population's buccal health condition. Methods: Cross- sectional descriptive correlative study with a stratified probabilistic sample of 90 children starting from a universe conformed by the 269 adolescents that constitute the total of the 12 years old population of the Health Care Area VIII in Cienfuegos municipality. Pearson’s chi-square and Mantel-Haenszel lineal tendency tests were used with the determination of the relative risk and reliance intervals of 95%. Results: The decay prevalence reached 54, 4%. The COP-D index was 2, 45 being the decayed component the major percentage with 4.6%. The periodontal disease was more frequent in boys than in girls, with 54, 9% and 30, 8% respectively. 80,9% of the segments is healthy. In those affected, the calculation prevailed in 11,7%. It was determined that faulty obturations, inheritance and faulty buccal hygiene were the most affecting risk factors for children with decays, while in the periodontal disease it was faulty buccal hygiene. Malocclusions presented a prevalence rate of 40%. Out of which, 55,6% required secondary level attention. Those with habits present a risk 2 times superior of making sick. The sick epidemiological category was present in 77,8% of the total. Conclusions: We emphasize the prevention need as core issue of the primary medical care in the world today; being the General-Integral Dentist a transforming agent that according to his/her formation is capable to assume the existent health problem and to modify it positively, acting from the earliest ages.

  14. Contextual and individual influences on diabetes and heart disease in Havana primary care catchment areas.

    Science.gov (United States)

    Díaz-Perera, Georgia; Bacallao, Jorge; Alemañy, Eduardo

    2013-04-01

    A population health profile is a cumulative product of socioenvironmental and political factors that create the contexts in which health problems arise, as well as opportunities and barriers to addressing them. Research on context has focused on demonstrating its effects, direct or indirect, on health indicators, but has made few incursions into assessing its role as a mediator of other factors. While individual risk factors for chronic diseases are well known, the same cannot be said for the complex of contextual factors operating at various levels and over the lifespan. Estimate relative influences by contextual versus individual factors as determinants of diabetes type 2 and heart disease. A cross-sectional study was carried out in populations served by 12 family doctor-and-nurse practices in Havana, in 840 families selected by simple random sampling, 70 per practice. Principal components analysis was used, as well as contextual logistic regression models with a nested model strategy, whose fit was meant to estimate the relative contributions of contextual compared to individual risk factors for diabetes and heart disease. Context was described and analyzed at two levels: that of the family or household and that of the catchment area served by a family doctor-and-nurse practice (geographically defined as a neighborhood). For diabetes, the contextual effect of neighborhood was modified when household effect was removed; that is, the effect of neighborhood was indirect and mediated by household. Individual coefficients were practically invariant; the principal effect of household changed noticeably on removal of individual effects, while age maintained its effect without variation. For heart disease, the effect of neighborhood was slightly modified when household effect was controlled for. Individual coefficients showed little change. There was an important direct effect of household on risk of heart disease. Age and high blood pressure coefficients hardly varied

  15. [Tuberculosis in a primary care center in a socioeconomically depressed area: variables associated with giving up treatment].

    Science.gov (United States)

    Solá, M; Gardella, A; Llauger, M A; Muñoz, J; Birulés, M; Foz, G

    1990-06-01

    We report the features of 72 patients with tuberculosis of a low socioeconomical level, seen at the primary care center of Perecamps (Barcelona). We identify the factors associated with giving up therapy. We found a predominance of males and of the 40-59 years age group. In 1988 we found an increased rate of young patients (20-39 years) and PDA/HIV+. Twenty-five patients (35%) had had previous episodes of tuberculosis. 19 had had inadequate chemotherapy because of abandonment. The rate of follow-up losses was high (36%). A history of previous PDA/HIV+ were associated with giving up therapy. We indicate the several measures to be applied in our area to improve compliance with chemotherapy in patients with tuberculosis.

  16. Rethinking the status of early childhood care and education (ECCE) in rural and urban areas of South Africa.

    Science.gov (United States)

    Goduka, I

    1997-07-01

    The purpose of this study was to document the current status of, and to determine the need for, early childhood care and education in South Africa. The study included an assessment of the training needs of child carers and other individuals interested in working with young children in urban and rural areas of the region. A total of 373 African men and women with varied occupations and educational attainment were recruited in the study. A survey methodology was employed to obtain desired information. The study showed that families and communities, who have previously responded to the needs of young children including education, health, and nutrition, could no longer meet these needs because of social and economic dynamics. Training, training centers, infrastructure, and the integration of African culture in early childhood are perceived to be compelling needs. Several recommendations for policy and programs are presented.

  17. Dental care knowledge and practices among secondary school adolescents in Ibadan North Local Government Areas of Oyo State, Nigeria

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    Tunde Joshua Ogunrinde

    2015-01-01

    Full Text Available Objective: To assess the dental care knowledge, and practice of secondary school adolescents in Ibadan North Local Government Area of Oyo State, Nigeria. Methodology: Four hundred and twelve secondary school adolescents were assessed using interviewer-administered questionnaire. Data on dental care knowledge and practice obtained through the questionnaire were analyzed using descriptive and inferential statistics with level of significance set at 5%. Result: Consumption of sticky, sugary and chocolaty food items was perceived by a majority (81.8% as unhealthy to dental health and 66.3% perceived consumption of fruits and vegetables as healthy to the teeth. Vertical brushing technique was mentioned by 69.7% of respondents as the best method of brushing the teeth, and 89.6% stated that teeth should be brushed twice daily. Majority 57.0% of respondents open caps of soft drink bottles with their teeth and 74.3% used toothpicks to remove food trapped in between teeth. Majority (82.8% perceived that dentist should be visited for check-up once in 6 months, however, only 31.6% of respondents had visited dentists before. There was a statistically significant relationship between tooth brushing technique and type of school attended by the respondents (P < 0.05. Conclusion: Majority of the respondents have good oral health knowledge but poor dental health practice.

  18. Placental malaria and lack of prenatal care in an area of unstable malaria transmission in eastern Sudan.

    Science.gov (United States)

    Adam, Ishag; Adamt, Gamal K; Mohmmed, Ahmed A; Salih, Magdi M; Ibrahuim, Salah A; Ryan, C Anthony

    2009-06-01

    A cross-sectional study was conducted in Gadarif Hospital in eastern Sudan to determine the prevalence, and evaluate the risk factors, of placental malaria. Two hundred and thirty-six delivering women were enrolled in the study. Socio-demographic characteristics were gathered through questionnaires. Maternal hemoglobin was measured, ABO blood groups were determined, and placental histological examinations for malaria were performed. The birth weight of the newborn was also recorded. The mean (SD) maternal age was 25.5 (6.0) yr and the mean (SD) hemoglobin was 9.8 (0.9) g/dl. Placental histology showed acute malaria infections in 13 (5.5%) and chronic infections in 5 (2.1%) women; 28 (11.9%) of the placentas revealed past infection and 190 (80.5%) indicated no infection. Lack of prenatal care was significantly associated with placental infections (OR = 12.0, 95% CI = 2.3-16.2; P = 0.003). There was no significant association between placental malaria infections and maternal age, parity, and blood group. Thirty-two (13.5%) of these pregnancy outcomes resulted in low birthweight babies. There was, however, no significant association between placental malaria and low birth weight (OR = 2.0, 95% CI = 0.4-4.1; P = 0.1). Thus, placental malaria infections affect pregnant women in this area of eastern Sudan regardless of their age or parity. Prenatal care should be encouraged to reduce malaria in the area. Much more research regarding malaria and pregnancy is needed.

  19. Application of comfort care in perioperative period of general surgery%舒适护理在普外科围手术期的应用探讨

    Institute of Scientific and Technical Information of China (English)

    史娟

    2014-01-01

    目的:探讨舒适护理在普外科患者围手术期护理中的应用效果。方法将142例普外科手术患者随机分为观察组和对照组各71例,对照组采用常规护理,观察组采用舒适护理,对比分析两组患者术后疼痛、心理状态及满意度情况。结果观察组患者术后12 h,24 h及48 h疼痛程度评分均明显低于对照组(2.81±0.21)vs (3.43±0.23),(2.61±0.12) vs (3.22±0.20),(2.50±0.14)vs(3.24±0.25),护理满意度评分明显低于对照组(89.72±5.63)vs.(98.28±5.91),术后人际关系、焦虑、抑郁、恐惧、强迫症状、敌对、躯体化评分均明显优于对照组(2.64±0.35)vs(1.10±0.27),(1.22±0.32)vs(0.69±0.11),(1.03±0.30)vs(1.64±0.46),(0.29±0.08)vs(1.18±0.41),(1.37±0.45)vs(1.90±0.46),(1.10±0.37)vs(1.33±0.52),(1.02±0.22)vs(1.17±0.37),差异有统计学意义(P<0.05或P<0.01)。结论围手术期舒适护理可明显缓解患者术后疼痛,改善心理状态,提高护理服务满意度,护理效果优于常规护理,值得临床推广应用。%Objective To investigate the nursing effect of comfort care in general surgery. Methods 142 patients underwent gener-al surgery were randomly divided into observation group and control group with 71 cases in each group. Patients in control group received routine care, while observation group received comfort care, the postoperative pain, mental status and satisfaction with the situation were compared between the two group. Results The pain scores postoperative 12h, 24h and 48h of observation group were significantly lower than those of the control group (2.81 ±0.21)vs (3.43 ±0.23), (2.61 ±0.12) vs (3.22 ±0.20), (2.50 ±0.14)vs (3.24±0.25); The care satisfaction scores were significantly lower than the control group(89.72±5.63) vs(98.28±5.91); The post-operative relationships, anxiety, depression, fear

  20. How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan

    Science.gov (United States)

    Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar