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Surgery Unit (surgery + unit)
Kinds of Surgery Unit Selected AbstractsAlternative approaches to obtain optimal bid values in contingent valuation studies and to model protest zeros.HEALTH ECONOMICS, Issue 2 2001Estimating the determinants of individuals' willingness to pay for home care services in day case surgery Abstract The use of day case surgery has increased rapidly as an alternative to inpatient surgery. Little is known, however, about the value of day case surgery to patients. The aim of this paper was to develop a contingent valuation survey to investigate how individuals value the costs of shifting from inpatient to day case surgery based on home care services. Using the willingness to pay (WTP) approach, two kinds of sequential experiments are compared: the maximum likelihood recursion (MLR) method and the C-optimal sequential procedure. The goal of sequential experimentation is to find bid values that provide the maximum possible information about the parameters of the WTP distribution, especially when the sample size is small. The C-optimal sequential procedure is shown to be an improvement, in terms of the statistical precision in small samples, over the MLR method. In addition, the paper presents a double hurdle (DH) approach for modelling the determinants of individuals' WTP. Using data from a contingent valuation survey conducted in 1996 on patients selected from the Day Case Surgery Unit in a hospital in the region of Catalonia, we argue that participation in the market offered and the level of consumption, that is, people's WTP, should be treated as individual choices. The results show that income and sex are related to WTP. Also, in this study, a clear presence of starting-point bias, introduced by the bid offered, was found. It is concluded that the WTP technique is potentially useful in evaluating health care programmes, although it is important to note that the criteria used to find an optimal design (in our model to minimize the asymptotic variance of the estimator used) may be restrictive from an economic point of view. Copyright © 2001 John Wiley & Sons, Ltd. [source] Controversies in the laparoscopic treatment of hepatic hydatid diseaseHPB, Issue 4 2004Koray Acarli Background Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients. Methods Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreato-biliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi. Results Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (I 1.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and I I years. Discussion Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopie retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations. [source] A challenging intervention with maternal anxiety: Babies requiring surgical correction of a congenital anomaly after missed prenatal diagnosisINFANT MENTAL HEALTH JOURNAL, Issue 6 2003Lucia Aite The objective of this study is to assess the impact on maternal anxiety of a short-term intervention in a particularly stressful situation, such as a surgical anomaly diagnosed only at birth after repeated negative prenatal ultrasounds. The patients were 30 mothers of babies requiring surgical correction of a congenital anomaly who were randomly assigned to an intervention (N = 16) or control (N = 14) group. The intervention group received standard care plus short-term intervention that included weekly meetings with the psychologist and weekly team meetings. The control group received only standard care available on the Neonatal Surgery Unit. The main outcome measure was maternal anxiety levels, assessed at birth and on discharge with the Spielberger State,Trait Anxiety Inventory (STAI,S). Statistical comparisons were made, and no significant differences were found at birth in the STAI,S scores of the two groups. At discharge, the intervention group exhibited a much lower STAI,S score than the group without short-term intervention. The authors concluded that psychological counseling for parents of newborn babies has been shown to be helpful. However, the impact of such assistance was shown to be particularly beneficial for parents facing the emotional stress of their children requiring unexpected surgical corrections of congenital anomalies at birth. Therefore, the presence of a psychologist, as part of the standard care of newborns requiring surgical correction, is recommended. ©2003 Michigan Association for Infant Mental Health. [source] Periodontal health and lateral lower lip piercings: a split-mouth cross-sectional studyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2009Miguel Angel Vilchez-Perez Abstract Aim: To assess periodontal health of individuals with a lateral lower lip piercing and describe associated periodontal, dental and mucosal complications. Material and Methods: A split-mouth study was performed in a sample of 50 patients with a lateral lower lip piercing who attended the Periodontal Pathology and Surgery Unit of the Dental School of the University of Barcelona. The patients underwent periodontal, dental and mucosal examination on both the piercing and the control sides. Results: Piercing users were predominantly women (78%), with a mean age of 21.3 years (SD=4.4). The amounts of keratinized and attached gingiva were significantly lower on the piercing side, and the prevalence of gingival recession was higher (p=0.012). The canine and first bicuspid teeth were the most affected. Tooth fractures and cracks were more frequent on the piercing side (20%) when compared with the control (4%). Mucosal alterations were found in seven patients. Conclusions: The use of lateral lower lip piercings enhances gingival recession and reduces the amounts of keratinized and attached gingiva. These ornaments are also associated with tooth fractures and cracks. [source] Eruptive squamous cell carcinomas, keratoacanthoma type, arising in a multicolor tattooJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2008Gary Goldenberg Permanent tattoos are formed through the injection of ink solids through the epidermis into the dermis and can cause multiple adverse reactions. We report a 38-year-old man who presented to our Dermatologic Surgery Unit with a diagnosis of a superficially invasive squamous cell carcinoma (SCC), keratoacanthoma (KA) type, of the left forearm in a 1-month-old tattoo. Since his initial biopsy, he developed four more similar lesions on his left forearm within his tattoo. On physical examination, the patient had a large, multicolor tattoo on his left forearm, a well-healed surgical biopsy site and four erythematous hyperkeratotic papules within differently pigmented areas of the patient's tattoo. Histopathological examination showed KA and tattoo pigment. Based on the eruptive nature of these lesions, their clinical presentation and the histopathological changes, we report this as the first case of eruptive KA arising in a multicolor tattoo. [source] The oral health status of patients on oral bisphosphonates for osteoporosisAUSTRALIAN DENTAL JOURNAL, Issue 4 2008R Kunchur Abstract Background:, The oral health status of patients on bisphosphonates is the key to the patient's ongoing health and well-being. If they are orally healthy, invasive bone procedures, particularly extractions can be avoided, then the risk of osteonecrosis of the jaws (ONJ) is low. Methods:, The records of 49 consecutive patients on oral bisphosphonates, referred to the Oral and Maxillofacial Surgery Unit (OMSU) for an oral health check and probable extractions, were retrospectively reviewed. The DMFT, periodontal and pathologic state were calculated from the OPG radiographs. An age and gender matched control group, from patients referred to the OMSU but who were not on oral bisphosphonates, were similarly assessed. Community data were also obtained. Results:, The DMFT score for the oral bisphosphonate group was 29: Decayed 3, Missing 10, Filled 16. The control group DMFT score was 24: Decayed 5, Missing 11, Filled 8. Both groups had advanced periodontal disease (over 95 per cent) and were medically compromised (over 90 per cent). The DMFT for general community data for age matched government pensioners was 19.1: Decayed 0.8, Missing 10.4, Filled 7.9. With severe periodontal disease 23 per cent. Thus, the oral health of the oral bisphosphonate group was similar to the control group and both had more decayed teeth and periodontal disease than community values. Conclusions:, This study confirms that one cannot assume that a patient on an oral bisphosphonate for osteoporosis has a healthy mouth. It supports the view that all patients on bisphosphonates need to be seen by a dentist either before or soon after commencement of bisphosphonate therapy. [source] The dental implications of bisphosphonates and bone diseaseAUSTRALIAN DENTAL JOURNAL, Issue 2005A. Cheng Abstract In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non-healing extraction wounds of the jaws. All were middle-aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non-healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates, pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non-osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients. [source] Patient Response to the Fast-Track ExperienceINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Jane Flanagan PURPOSE To describe patients' functional health, symptom distress, and recovery at home across a fasttrack perioperative experience. METHODS A nonexperimental, descriptive, correlational design using pre/post test measures and openended questions captured the fast-tracking experience. A convenience sample included 77 patients entering the same-day surgery unit to undergo arthroscopy with general anesthesia and planned fast-track recovery. In the preadmission test area, patients were asked by a nurse to participate in the study. If they agreed and met selection criteria, a nurse completed a demographic sheet, the Foster and Jones Functional Health Pattern Assessment Screeing Tool (FHPAST), and the Symptom Distress Scale (SDS). On the evening of surgery, a nurse called the patient to review the SDS to be completed by phone. At 72 hours after surgery, the FHPAST, the SDS, and a 72-hour open-ended questionnaire were administered to understand the patient experience of fast-tracking. FINDINGS At 12 hours nurses reported patients were "euphoric" and it was difficult to imagine pain or other symptoms. Some patients complained of nausea and fatigue. Most patients had family present. At 72 hours patients described unmet expectations, fatigue, immobility, ineffective pain management, sleep disturbance, and nausea. Interventions included teaching, coaching, and reassurance. Some patients continued to have nursing problems at 72 hours and benefited from a telephone follow-up call. CONCLUSIONS Preliminary results suggest that nursing diagnoses, interventions, and outcomes can be used to describe patient responses to the fast-track experience. Results indicate a need for practice changes to include innovative models and further research to measure outcomes. Fast-tracking can be effective, but requires clinical reasoning by nurses to guide the individual's healing. A coaching intervention seems to enhance patient satisfaction and a sense of being cared for. [source] Amyloidosis: a rheumatological perspective on diagnosis, further investigation and treatmentINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 1 2008S. K. L. LAM Abstract In this Grand Round, we present a 58-year-old man with a presumptive diagnosis of rheumatoid arthritis (RA) who was being managed by a plastic surgery unit for a dorsal swelling of his right hand. While awaiting surgery for this lesion, he sustained a pathological fracture of his left neck of femur. This necessitated a total hip joint replacement and pathology revealed amyloidosis. Excision of the hand swelling also revealed amyloidosis as the cause. We discuss the ways in which amyloidosis can mimic musculoskeletal disease as well as the importance and some potential pitfalls of further investigation and management once the diagnosis of amyloidosis has been made. [source] Structure and organization of a microsurgically oriented plastic surgery unitMICROSURGERY, Issue 2 2004G. Germann M.D., Ph.D. [source] Bradycardia and asystolic cardiac arrest during spinal anaesthesia: A report of five casesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2000R. Z. Løvstad Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. Bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10,70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae. [source] Developing teaching opportunities in a day surgery unitTHE CLINICAL TEACHER, Issue 3 2006Amir Hanna First page of article [source] Functional impairment after latissimus dorsi flapANZ JOURNAL OF SURGERY, Issue 1-2 2009Cherry E. Koh Abstract Background:, Available published reports suggest that loss of latissimus dorsi muscle following latissimus myocutaneous flap does not lead to functional impairment. However, significant functional impairment has been observed in clinical practice, prompting this study to evaluate the functional deficit in patients who had undergone reconstruction using latissimus dorsi muscle. Methods:, A retrospective review was undertaken between 1998 and 2003. Patients were identified from the audit of the plastic surgery unit at St Vincent's Hospital and recruited by direct telephone contact. They were assessed using the Disability of Arm, Shoulder and Hand questionnaire. Results:, There were 25 participants. Eighteen completed their questionnaires. Six of 18 patients reported scores of 30 or more, which corresponded to a global moderate functional deficit. These patients were severely limited in their ability to carry out housework. Major postoperative complications were associated with high Disability of Arm, Shoulder and Hand scores (P = 0.028). Three of five patients involved with sports reported impaired performance in sports. The subgroup of four patients who underwent bilateral latissimus dorsi flaps also experienced significant morbidity with all four reporting moderate to severe impairment in their ability to return to gardening and/or sports. Conclusion:, Patients undergoing this procedure should be fully informed of potential sequelae. Athletic patients and patients undergoing bilateral latissimus dorsi flaps should also be warned of possible reduced performance in sports. Alternatively, perforator cutaneous flaps, which preserve the latissimus muscle, should be chosen when feasible. [source] Prevalence and treatment of hypercholesterolaemia in patients with peripheral vascular diseaseBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000S. M. Evans Background: Hypercholesterolaemia is a recognized risk factor for the development of arteriosclerosis. There is compelling evidence to support the use of lipid-lowering strategies in all hypercholesterolaemic patients with arteriosclerotic disease. In peripheral arterial disease (PAD), national guidelines recommend treatment if total cholesterol exceeds 5·0 mmol l,1. The prevalence of hypercholesterolaemia in patients with PAD was determined and the adequacy of lipid management before vascular referral was examined. Methods: This was a prospective study of 233 consecutive patients admitted electively to this vascular surgery unit between December 1997 and December 1998. Some 68 patients were admitted with carotid disease, 81 with an aneurysm and 84 with intermittent claudication. A fasting venous blood sample was obtained from each patient. Results: There were 175 men and 58 women, of median age 67 (range 37,85) and 68 (range 47,85) years respectively. Only 35 patients (15 per cent) were previously known to be hypercholesterolaemic; all but one were receiving treatment (one dietary, 33 statin). Of the remaining 198 patients, 124 (63 per cent) had a serum cholesterol level above 5·0 mmol l,1. A further 17 patients (9 per cent) had total cholesterol/high-density lipoprotein: cholesterol ratio greater than 5·0; these patients may also benefit from lipid-lowering therapy. In total, 141 (80 per cent) of 176 hypercholesterolaemic patients were undiagnosed at the time of hospital admission. Conclusion: Hypercholesterolaemia is an important and correctable risk factor found in the majority of patients with PAD, but despite national guidelines and clear evidence from randomized controlled trials it is simply not being diagnosed in primary care. All elective patients with PAD should be screened for hypercholesterolaemia during their admission. © 2000 British Journal of Surgery Society Ltd [source] Delays in the diagnosis of anorectal malformations are common and significantly increase serious early complicationsACTA PAEDIATRICA, Issue 3 2006Richard M Lindley Abstract Aim: To clarify the extent of delayed diagnosis of anorectal malformations and the consequences of delaying this diagnosis. Methods: We performed a retrospective case review of all neonatal admissions with an anorectal malformation to a tertiary paediatric surgery unit. A delayed diagnosis was considered to be one made 24 h or more after birth. Results: 75 patients were included in the study group: 31 (42%) had a delay in the diagnosis; 44 (58%) had no delay in the diagnosis. The time of diagnosis where a delay had occurred ranged from 2,16 (median 2) d. A delay in diagnosis could not be accounted for by differences in age, sex, birthweight, gestational age, the severity or visibility of the lesion, the need for neonatal special or intensive care, or the presence of other anomalies. There were significantly more complications (including one death) amongst the group of children who had a delay in the diagnosis of an anorectal malformation. There was no significant difference in long-term functional outcome. Conclusion: Delays in the diagnosis of anorectal malformations are much more common than previously thought. A delay in diagnosis significantly increases the risk of serious early complications and death. [source] Postoperative monitoring of free flaps in UK plastic surgery unitsMICROSURGERY, Issue 6 2005Ch.B. (Hons.), M.R.C.S. (Eng.), N. Jallali B.Sc. Monitoring free-tissue transfers in the postoperative period is valuable for detection of failing flaps. As well as conventional methods, a myriad of sophisticated techniques have been reported in the literature. Using a postal questionnaire, a survey was conducted to delineate current protocols employed in UK plastic surgery units. Data were received from 148 plastic surgeons in 51 units. All surgeons used clinical assessment, although there was significant disparity in the duration and frequency of postoperative monitoring. Adjuvant techniques such as laser Doppler flowmetry were routinely used by less than 20% of surgeons. We conclude that there is considerable variation in postoperative monitoring of free flaps, with significant clinical and resource implications. A protocol based on robust evidence is thus recommended. © 2005 Wiley-Liss, Inc. Microsurgery 25:469,472, 2005. [source] Acute surgery units: the future face of emergency surgeryANZ JOURNAL OF SURGERY, Issue 7-8 2010FRACS, Phil Truskett MB BS Syd No abstract is available for this article. [source] | ||||||||||