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1 – 10 of 327Khwanhathai Changyai, Puangpaka Kongvattananon and Chomchuen Somprasert
The purpose of this paper is to synthesize the experiences and needs of colorectal cancer patients during postoperative recovery.
Abstract
Purpose
The purpose of this paper is to synthesize the experiences and needs of colorectal cancer patients during postoperative recovery.
Design/methodology/approach
This study is an integrative review, conducted by CINAHL, PubMed, ScienceDirect and ThaiJO from 2009 to 2019. Ten research articles published have been selected by PRISMA process.
Findings
Results show the experiences of colon cancer patients during postoperative recovery consisted of four themes, namely suffering, decreased activity, ambivalent feeling and need of caring.
Research limitations/implications
The health care personnel should be aware of these experiences and give holistic care in order to let the patients free from unpleasant experiences and receive the responses which really meet their needs.
Originality/value
Knowledge about the experience and needs of colorectal cancer patients after surgery is of great benefit to healthcare providers who are planning the care, so as to achieve complete holistic care in the future research.
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Sandra Verelst, Jessica Jacques, Koen Van den Heede, Pierre Gillet, Philippe Kolh, Arthur Vleugels and Walter Sermeus
The purpose of this article is to assess the reliability of an in‐depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse…
Abstract
Purpose
The purpose of this article is to assess the reliability of an in‐depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse events in acute hospitals: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator‐associated pneumonia and postoperative wound infection.
Design/methodology/approach
The analysis uses a retrospective medical record review of 1,515 patient records by two independent teams in eight acute Belgian hospitals for the year 2005. The Mann‐Whitney U‐test is used to identify significant differences between the two review teams regarding occurrence of adverse events as well as regarding the degree of causation, preventability, and disability of found adverse events.
Findings
Team 1 stated a high probability for health care management causation in 95.5 per cent of adverse events in contrast to 38.9 per cent by Team 2. Likewise, high preventability was considered in 83.1 per cent of cases by Team 1 versus 51.7 per cent by Team 2. Significant differences in degree of disability between the two teams were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but not for postoperative sepsis and ventilator‐associated pneumonia.
Originality/value
New insight on the degree of and reasons for the huge differences in adverse event evaluation is provided.
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Susan Griffin, Leigh McGrath, Gregory T. Chesnut, Nicole Benfante, Melissa Assel, Aaron Ostrovsky, Marcia Levine, Andrew Vickers, Brett Simon and Vincent Laudone
The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative…
Abstract
Purpose
The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes.
Design/methodology/approach
This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates.
Findings
Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified.
Originality/value
This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
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Sandeep W. Dahake, Abhaykumar M. Kuthe and Mahesh B. Mawale
This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated…
Abstract
Purpose
This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated customized implant fixation in mandibular reconstructions.
Design/methodology/approach
In all, 30 diseased mandibular RP models (biomodels) were allocated for the study (for experimental group [n = 15] and for control group [n = 15]). To reconstruct the mandible with customized implant in the experimental group, CSOGs and in control group, no CSOG were used for accurate tumor resections. In control group, only preoperative virtual surgical planning (VSP) and reconstructed RP mandible model were used for the reference. Individually each patient’s preoperative mandibular reconstructions data of both the groups were superimposed to the preoperative VSP of respective patient by registering images with the non-surgical side of the mandible. In both the groups, 3D measurements were taken on the reconstructed side and compared the preoperative VSP and postoperative reconstructed mandible data. The sum of the differences between pre and postoperative data was considered as the total error. This procedure was followed for both the groups and compared the obtained error between the two groups using statistical analysis.
Findings
The use of CSOG for accurate tumor resection and exact implant fixation in mandibular reconstruction produced a smaller total error than without using CSOG.
Originality/value
The results showed that, benefits provided with the use of CSOG in mandibular reconstruction justified its use over the without using CSOG, even in free hand tumor resection using rotating burr.
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Carlo Ricciardi, Alfonso Sorrentino, Giovanni Improta, Vincenzo Abbate, Imma Latessa, Antonietta Perrone, Maria Triassi and Giovanni Dell'aversana Orabona
Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the…
Abstract
Purpose
Head and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.
Design/methodology/approach
The Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).
Findings
The results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.
Research limitations/implications
While the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.
Practical implications
Employing the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.
Originality/value
There is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.
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The purpose of the paper is to report a case of bilateral inferior iridoschisis who underwent cataract surgery with intraocular lens implantation successfully with the help of…
Abstract
Purpose
The purpose of the paper is to report a case of bilateral inferior iridoschisis who underwent cataract surgery with intraocular lens implantation successfully with the help of iris hooks or pupillary expanders.
Design/methodology/approach
A 71-year-old male presented with inferior iridoschisis in both eyes, history of angle closure glaucoma (ACG), cataract and shallow anterior chamber (AC) angles inferiorly. A localized area of iris stroma is cleaved in two with anterior atrophic portion disintegrating into fibrils from the posterior stroma, and muscle layer is termed as iridoschisis. Iridoschisis is a rare condition associated with fibrillary iris degeneration, narrow drainage angles and cataract.
Findings
Preoperative and postoperative ocular examination, including visual acuity, intraocular pressure and degrees of iris damage, was evaluated. Cataract surgery was performed under topical anesthesia with flexible iris hooks. There were no intraoperative complications whereas marked corneal edema was shown at immediate postoperative period but subsided completely in two weeks’ time. Visual acuity improved from 20/60 to 20/25.
Practical implications
This case report demonstrates that while iridoschisis care during cataract surgery has been reported to be difficult, cataract extraction was managed using iris hooks.
Originality/value
This paper reports the successful management of cataract in a patient with bilateral inferior iridoschisis.
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Mark Simmonds and Mrs Peggy Edwards
For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of…
Abstract
For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of patients awoke from anaesthesia in ‘pain’ and 10% were discharged to the ward in ‘pain’. Thirty‐seven per cent of patients using patient‐controlled analgesia (PCA) in the recovery room were discharged in ‘pain’; 63% of these patients had neither been prescribed nor given a ‘loading dose’ in the recovery room. Forty‐eight per cent of patients receiving sole intramuscular opioid analgesia were discharged in ‘pain’. Ninety per cent who received nurse‐administered ‘prn’ intravenous bolus opioids were discharged ‘comfortable’. An algorithm was therefore developed for the administration of loading doses of intravenous opioids in the recovery unit to be used by recovery nursing staff prior to PCA or other analgesic methods. An early re‐audit established that the algorithm became widely adopted by anaesthetists, was safe and produced comparable discharge pain scores.