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Surgical Patients (surgical + patient)
Kinds of Surgical Patients Selected AbstractsA qualitative evaluation of the Care of the Critically Ill Surgical Patient courseANZ JOURNAL OF SURGERY, Issue 10 2009Mario Giuseppe Zotti Abstract Background:, The Care of the Critically Ill Surgical Patient (CCrISP) course was adapted by the Royal Australasian College of Surgeons, being made compulsory for all Basic Surgical Trainees in 2001. The aim of this study was to evaluate whether the course objectives were achieved and identify strengths and weaknesses. Methods:, A retrospective cohort study was completed, after CCrISP Committee support of the proposed conduct, by distribution of questionnaires to instructors and trainees who had completed CCrISP in 2006 or earlier. The questionnaires were qualitative and designed to evaluate the success of CCrISP objectives. Results:, Fourteen instructors and 40 Victorian trainees completed the questionnaires. The major weaknesses identified by the instructors were the trainees' management of complications, nutrition, multiple injuries and sedation, procedural skills and mentoring. Trainees identified weaknesses in procedural skills and mentoring. Both groups identified the strongest areas being the emphasis on communication skills, utilization of clinical knowledge and acumen, management of shock and haemorrhage and management of the acute abdomen. The trainees further identified the systematic approach to the critically ill surgical patient as a major strength. Conclusion:, The primary objectives of the CCrISP course have been met. This study has identified teaching of communication skills, shock and haemorrhage and the systematic approach being the strengths of the course, whereas further refining of the mentoring process and reconsidering the importance of procedural skills is needed, both of which are secondary objectives. [source] Medical Management of the Surgical Patient.BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 20074th Edn. No abstract is available for this article. [source] Relative Importance of Preoperative Health Status Versus Intraoperative Factors in Predicting Postoperative Adverse Outcomes in Geriatric Surgical PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2001Jacqueline M. Leung MD First page of article [source] Surgical Patients, Nursing Careers at Risk When Caseloads IncreaseNURSING FOR WOMENS HEALTH, Issue 1 2003Carolyn Davis Cockey MS executive editor No abstract is available for this article. [source] Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2010G. Testa No abstract is available for this article. [source] In Response to: Testa et al. ,Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical Innovation'AMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010E. J. Gordon No abstract is available for this article. [source] Letter to the Editor in Response to: Gordon et al., Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical Innovation by Testa et al.AMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010Giuliano Testa No abstract is available for this article. [source] Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009G. Testa We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which ,creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation. [source] Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imagingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2005M. Nolli We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke,Korsakoff syndrome with ataxia and memory and cognitive defects. Thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition. [source] Fast tracking the paediatric cardiac surgical patientPEDIATRIC ANESTHESIA, Issue 3 2000Carol L. Lake MD First page of article [source] Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009G. Testa We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which ,creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation. [source] A qualitative evaluation of the Care of the Critically Ill Surgical Patient courseANZ JOURNAL OF SURGERY, Issue 10 2009Mario Giuseppe Zotti Abstract Background:, The Care of the Critically Ill Surgical Patient (CCrISP) course was adapted by the Royal Australasian College of Surgeons, being made compulsory for all Basic Surgical Trainees in 2001. The aim of this study was to evaluate whether the course objectives were achieved and identify strengths and weaknesses. Methods:, A retrospective cohort study was completed, after CCrISP Committee support of the proposed conduct, by distribution of questionnaires to instructors and trainees who had completed CCrISP in 2006 or earlier. The questionnaires were qualitative and designed to evaluate the success of CCrISP objectives. Results:, Fourteen instructors and 40 Victorian trainees completed the questionnaires. The major weaknesses identified by the instructors were the trainees' management of complications, nutrition, multiple injuries and sedation, procedural skills and mentoring. Trainees identified weaknesses in procedural skills and mentoring. Both groups identified the strongest areas being the emphasis on communication skills, utilization of clinical knowledge and acumen, management of shock and haemorrhage and management of the acute abdomen. The trainees further identified the systematic approach to the critically ill surgical patient as a major strength. Conclusion:, The primary objectives of the CCrISP course have been met. This study has identified teaching of communication skills, shock and haemorrhage and the systematic approach being the strengths of the course, whereas further refining of the mentoring process and reconsidering the importance of procedural skills is needed, both of which are secondary objectives. [source] Detecting Adverse Events in Dermatologic SurgeryDERMATOLOGIC SURGERY, Issue 1 2010DANIEL PINNEY BS BACKGROUND Despite increasing awareness of and public attention to patient safety, little is documented about how adverse events (AEs) can or should be monitored in dermatologic surgery. Data to address this shortcoming are needed, although well-defined methodologies have yet to be implemented. OBJECTIVE To summarize current strategies in detecting adverse outcomes of dermatologic surgical procedures. MATERIALS AND METHODS A Medline literature search was conducted using the terms "adverse event,""detection,""reporting,""monitoring," and "surgery." Articles selected addressed the efficacy of one or more AE reporting techniques in surgical patients. RESULTS Prospective and retrospective reporting methods were identified, with morbidity and mortality conference being the most commonly used method of AE reporting. Retrospective medical record review, the retrospective trigger tool approach, and an anonymous electronic reporting system were more sensitive approaches. The Surgical Quality Improvement Program, a program that has successfully translated AE data into lower postoperative morbidity and mortality, was analyzed. CONCLUSIONS Although generally considered safe, dermatologic surgery has no current standard for AE reporting. Standard definitions and high-quality data regarding AEs" currently limit this analysis. Pilot studies are needed to develop feasible measures, with the goal of increasing the sensitivity of AE detection and ultimately improving patient outcomes. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories. [source] Dietary Supplements in the Setting of Mohs SurgeryDERMATOLOGIC SURGERY, Issue 6 2002Siobhan C. Collins MD background. The use of dietary supplements has become increasingly popular. While many are safe in small doses, others may have potentially harmful effects, particularly in surgical patients. objective. To study the incidence of dietary supplement use in patients presenting for Mohs surgery. methods. One hundred consecutive patients presenting for Mohs surgery completed a questionnaire providing all current medications. During the consultation, the patients were then asked specifically about their current use of any dietary supplements. Responses differing from those on the questionnaire were recorded. results. Forty-nine of 100 patients (49%) were currently taking dietary supplements. Of this group, 17 patients (35%) self-reported the use of supplements; 32 patients (65%) did not. Thirty women (59%) were currently using dietary supplements regularly compared to 19 men (39%). Women were also more likely to self-report the use of supplements compared to men: 14 women (47%) versus three men (15%). Forty-eight of the 100 study patients (48%) were currently taking anticoagulant medications such as aspirin, warfarin, nonsteroidal anti-inflammatory drugs (NSAIDs), or clopidogrel bisulfate. Fifty instances were noted where patients were taking one or more dietary supplements that have demonstrated anticoagulant properties. Of this group, 21 instances (42%) where patients took a combination of prescription and over-the-counter (OTC) anticoagulants and one or more dietary supplements shown to have effects on coagulation were recorded. conclusion. Of the almost 50% of patients taking dietary supplements, one-third reported usage, while two-thirds did not. Women used dietary supplements more frequently than men and were more than three times more likely to offer this information. Furthermore, many supplements have been shown to have effects on coagulation, including vitamin E, garlic, ginkgo, feverfew, and fish oils. Use of these substances alone or in combination may potentiate the anticoagulant effects of each other or prescribed medications. It is therefore important for the dermatologic surgeon to communicate openly with patients regarding dietary supplements to avoid potential complications during or following surgery. [source] Common infections in diabetes: pathogenesis, management and relationship to glycaemic controlDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2007Anton Y. Peleg Abstract Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo-responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community- and hospital-acquired infections. Copyright © 2006 John Wiley & Sons, Ltd. [source] Focal Ictal , Discharge on Scalp EEG Predicts Excellent Outcome of Frontal Lobe Epilepsy SurgeryEPILEPSIA, Issue 3 2002Gregory A. Worrell Summary: ,Purpose: To determine whether a focal ,-frequency discharge at seizure onset on scalp EEG predicts outcome of frontal lobe epilepsy (FLE) surgery. Methods: We identified 54 consecutive patients with intractable FLE who underwent epilepsy surgery between December 1987 and December 1996. A blind review of EEGs and magnetic resonance images (MRIs) was performed. Lesional epilepsy is defined as presence of an underlying structural abnormality on MRI. Results: Overall, 28 (52%) patients were seizure free, with a mean follow-up of 46.5 months. Presence of a focal ,-frequency discharge at seizure onset on scalp EEG predicted seizure-free outcome in lesional (p = 0.02) and nonlesional (p = 0.01) epilepsy patients. At least 90% of patients who had either lesional or nonlesional epilepsy were seizure free if scalp EEG revealed a focal , discharge at ictal onset. Moreover, logistic regression analysis showed that focal ictal , pattern and completeness of lesion resection were independently predictive of seizure-free outcome. Ictal onset with lateralized EEG activity of any kind and postresection electrocorticographic spikes did not predict surgical outcome (p > 0.05). Conclusions: Only about 25% of FLE surgical patients have a focal ,-frequency discharge at seizure onset on scalp EEG. However, its presence is highly predictive of excellent postsurgical seizure control in either lesional or nonlesional FLE surgical patients. [source] Prevention of wound complications following salvage laryngectomy using free vascularized tissueHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007FRCS(C), Kevin Fung MD Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] The Relationship of Post-acute Home Care Use to Medicaid Utilization and ExpendituresHEALTH SERVICES RESEARCH, Issue 3 2002Susan M. C. Payne Research Objectives: To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. Study Population: 5,299 Medicaid patients aged 18,64 discharged in 1992,1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Data Sources: Linked Ohio Medicaid claims and CHQC medical record abstract data. Data Extraction: One stay per patient was randomly selected. Design: Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Principal Findings: Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p<.05) and surgical patients after 90 and 180 days (p<.001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Conclusions: Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted. [source] Measuring the quality of hospital care: an inventory of indicatorsINTERNAL MEDICINE JOURNAL, Issue 6 2009B. Copnell Abstract Background: Development of indicators to measure health-care quality has progressed rapidly. This development has, however, rarely occurred in a systematic fashion, and some aspects of care have received more attention than others. The aim of this study is to identify and classify indicators currently in use to measure the quality of care provided by hospitals, and to identify gaps in current measurement. Methods: A literature search was undertaken to identify indicator sets. Indicators were included if they related to hospital care and were clearly being collected and reported to an external body. A two-person independent review was undertaken to classify indicators according to aspects of care provision (structure, process or outcome), dimensions of quality (safety, effectiveness, efficiency, timeliness, patient-centredness and equity), and domain of application (hospital-wide, surgical and non-surgical clinical specialities). Results: 383 discrete indicators were identified from 22 source organizations or projects. Of these, 27.2% were relevant hospital-wide, 26.1% to surgical patients and 46.7% to non-surgical specialities, departments or diseases. Cardiothoracic surgery, cardiology and mental health were the specialities with greatest coverage, while nine clinical specialities had fewer than three specific indicators. Processes of care were measured by 54.0% of indicators and outcomes by 38.9%. Safety and effectiveness were the domains most frequently represented, with relatively few indicators measuring the other dimensions. Conclusion: Despite the large number of available indicators, significant gaps in measurement still exist. Development of indicators to address these gaps should be a priority. Work is also required to evaluate whether existing indicators measure what they purport to measure. [source] Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. ESCHERTZHUBER Background: This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients. Methods: Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated. Results: Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01,4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5,1.0) l/min] than in the uncuffed ETT group [2.0 (0.5,4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4,82.8) ml in the uncuffed ETT group and 6.2 (1.1,14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53,552) l in the uncuffed ETT group vs. 46 (9,149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0,67.3),/patient in the uncuffed ETT group and 5.2 (1.0,12.5),/patient in the cuffed ETT group, P<0.001. Conclusions: The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption. [source] Spectral entropy monitoring allowed lower sevoflurane concentration and faster recovery in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. R. CHOI Background: Anesthetic titration using spectral entropy monitoring reduces anesthetic requirements and shortens recovery in adult surgical patients. This study was performed to evaluate the effect of entropy monitoring on end-tidal sevoflurane concentration and recovery characteristics in pediatric patients undergoing sevoflurane anesthesia. Methods: Seventy-eight children (aged 3,12 years) scheduled for a tonsillectomy and/or an adenoidectomy were randomly divided into one of two groups: standard practice (Standard) or entropy-guided (Entropy). In the Standard group, sevoflurane was adjusted to maintain the heart rate and systolic blood pressure (BP) within 20% of the baseline values. In the Entropy group, sevoflurane was adjusted to achieve a state entropy of 40,50. We compared the entropy values, end-tidal sevoflurane concentration and recovery times between groups. Results: During maintenance of anesthesia, the entropy and BP values were higher in the Entropy group (P<0.05). The end-tidal sevoflurane concentration during maintenance was lower in the Entropy group (2.2 (0.3) vol%) compared with the Standard group (2.6 (0.4) vol%) (P<0.05). Recovery times were faster in the Entropy group (P<0.05). Conclusions: Compared with standard practice, we found that entropy-guided anesthetic administration was associated with a reduced sevoflurane concentration and a slightly faster emergence and recovery in 3,12-year-old children. [source] Functional intravascular volume deficit in patients before surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010M. BUNDGAARD-NIELSEN Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ,10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit. Results: Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200,600 ml), with no significant difference between the three groups of patients. The required volume was ,400 ml in nine patients (15%). Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal-directed fluid therapy. [source] Patients' perceptions of nursing care in the hospital settingJOURNAL OF ADVANCED NURSING, Issue 4 2003Lee A. Schmidt PhD RN Background., Patient satisfaction and patient satisfaction with nursing care data are routinely collected as an indicator of the quality of services delivered. Despite the widespread collection and reporting of these data, the theoretical basis of patient satisfaction and patient satisfaction with nursing care remains unclear. Without a clear theoretical base, interpretation of patient satisfaction findings is hampered and the entire line of patient satisfaction research is of questionable validity. It has been suggested that, to understand patient satisfaction, patient perceptions of their care must first be understood. Aim., The aim of this study was to discover patients' perceptions of the nursing care they receive in the hospital setting. Method., Grounded theory method was used in this study of eight medical,surgical patients recently discharged from an academic medical centre in the south-eastern United States of America (USA). Participants were interviewed and the verbatim transcripts analysed using the constant comparative method. Findings., Four categories of patient perceptions of their nursing care emerged from the data. ,Seeing the individual patient' captures the unique nature of the nursing care experience for each patient. ,Explaining' represents the informal explanations given by nursing staff as they provide care. ,Responding' refers to both the character and timeliness of nursing staff's responses to patient requests or symptoms. ,Watching over' represents the surveillance activities of nursing staff. Conclusions., The categories identified in this study may be used in efforts to further develop a formal theory of patient satisfaction with nursing care. These categories should also be tested with patients possessing a wider range of characteristics, to assess the transferability of the findings. [source] Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care MedicineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010H. BREIVIK Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. Methods: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Results: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Conclusions: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info. [source] "Cracking and Paving": A Novel Technique to Deliver a Thoracic Endograft Despite Ilio-Femoral Occlusive DiseaseJOURNAL OF CARDIAC SURGERY, Issue 2 2009Jacques Kpodonu M.D. High-risk surgical patients with ilio-femoral occlusive disease may not be amenable to general anesthesia and the construction of a retroperitoneal conduit. Methods and Results: We report the use of a novel technique consisting of cracking and paving of the ilio-femoral vessels with balloon angioplasty, followed by deployment of an endoconduit to deliver an endoluminal graft under local sedation to treat a high-risk 80-year-old patient with a thoracic aneurysm. Conclusion: High-risk surgical patients with iliofemoral disease can undergo endoluminal graft therapy to threat thoracic aortic aneurysms. [source] Open Heart Surgery in Patients 85 Years and OlderJOURNAL OF CARDIAC SURGERY, Issue 1 2004Wellington J. Davis III M.D. Several reports have documented acceptable morbidity and mortality in patients 80 years and older. The results from surgical patients 85 years and older were analyzed. Methods: The records of 89 consecutive patients 85 years and older having cardiac operations between June 1993 and May 1999 were retrospectively reviewed. For purposes of statistical analysis follow-up was considered as a minimum of one office visit to the surgeon, cardiologist, or internist at least 1 month postoperatively. Results: Eighty-seven patients underwent coronary artery grafting and two patients had mitral valve replacement. Follow-up was 100% complete. The operative mortality rate was 12.3%; probability of in-hospital death was 8.2%; risk-adjusted mortality rate was 3.2%. The complication rate was 31.5%. The actuarial 1-, 3-, and 5-year survivals were as follows: 75%, 67%, and 40%. Multivariate predictors of 30-day mortality were preoperative EF, less than 30% (p = 0.029) and postoperative renal failure (p = 0.0039). Conclusions: Cardiac surgery can be performed in patients 85 years and older with good results. There is an associated prolonged hospital stay for elderly patients. Consistent successful outcomes can be expected in this patient population with selective criteria identifying risk factors. (J Card Surg 2004;19:7-11) [source] A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermiaJOURNAL OF CLINICAL NURSING, Issue 5 2009Cristina M Galvão Aims., To retrieve and critique recent randomised trials of cutaneous warming systems used to prevent hypothermia in surgical patients during the intraoperative period and to identify gaps in current evidence and make recommendations for future trials. Background., Hypothermia affects up to 70% of anaesthetised surgical patients and is associated with several significant negative health outcomes. Design., Systematic review using integrative methods. Methods., We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline databases (January 2000,April 2007) for recent reports on randomised controlled trials of cutaneous warming systems used with elective patients during the intraoperative period. Inclusion criteria., We included randomised control trials examining the effects of cutaneous warming systems used intraoperatively on patients aged 18 years or older undergoing non-emergency surgery. Studies published in English, Spanish or Portuguese with a comparison group that consisted of either usual care or active cutaneous warming systems without prewarming were reviewed. Results., Of 193 papers initially identified, 14 studies met the inclusion criteria. There was moderate evidence to indicate that carbon-fibre blankets and forced-air warming systems are equally effective and that circulating-water garments are most effective for maintaining normothermia during the intraoperative period. Few trials reported costs. Conclusions., Carbon-fibre blankets and forced-air warming systems are effective and circulating-water garments may be preferable. Future research should measure the direct and indirect costs associated with competing systems. Relevance to clinical practice., Nurses can use this review to inform their selection of warming interventions in perioperative nursing practice. They can also assess other factors such as nursing workload, staff training and equipment maintenance, which should be incorporated into future research. [source] The Norwegian version of the American pain society patient outcome questionnaire: reliability and validity of three subscalesJOURNAL OF CLINICAL NURSING, Issue 15 2008Alfhild Dihle MSc Aims and objectives., To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire (APS-POQ-N). Background., This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed. Methods., The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory (modified BPI subscale), the subscale on satisfaction with pain management (Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct validity was evaluated using principal-axis factor analysis with oblimin rotation. Results., Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale. Conclusions., The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients. However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose. Relevance to clinical practice., Reliable and valid instruments are important when performing clinical research. This instrument is applicable as an indicator of quality of postoperative pain management in clinical practice and research. [source] Family involvement in perioperative nursing of adult patients undergoing emergency surgeryJOURNAL OF CLINICAL NURSING, Issue 2 2001Eija Paavilainen PhD ,,The purpose of this study was to describe how adult patients undergoing emergency surgery experience family centredness in perioperative nursing practice. The central aim was to generate knowledge to be used while developing the practice, education and management of perioperative nursing. ,,Data were collected using a questionnaire with emergency surgical patients in five regional hospitals in Southern Finland. The number of distributed questionnaires was 132. The response rate was 85% (n=112). ,,The results were mainly described as frequencies and percentages. The open-ended sections of the answers were analysed using qualitative content analysis. The findings from the open-ended questions were used for deepening and complementing the quantitative description of the results. ,,In the preoperative phase, ascertaining the family situation and informing the family member chosen by the patient were not achieved systematically. Family situation was also rarely examined in the intraoperative and postoperative phases, although it is central to coping after surgery, especially in home care. ,,The results support the view of earlier research about the importance of individuality of patients and their families during the perioperative care process and hence enhance the endeavour to develop nursing based on families' real needs. [source] Pre-operative hemodynamics in cardiac surgical patients: What do the numbers really mean?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009P. León No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||