1
|
Piriyapatsom A, Trisukhonth A, Chintabanyat O, Chaiwat O, Kongsayreepong S, Thanakiattiwibun C. Adherence to lung protective mechanical ventilation in patients admitted to a surgical intensive care unit and the associated increased mortality. Heliyon 2024; 10:e26220. [PMID: 38404779 PMCID: PMC10884462 DOI: 10.1016/j.heliyon.2024.e26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background The adherence rate to the lung protective ventilation (LPV) strategy, which is generally accepted as a standard practice in mechanically ventilated patients, reported in the literature is approximately 40%. This study aimed to determine the adherence rate to the LPV strategy, factors associated with this adherence, and related clinical outcomes in mechanically ventilated patients admitted to the surgical intensive care unit (SICU). Methods This prospective observational study was conducted in the SICU of a tertiary university-based hospital between April 2018 and February 2019. Three hundred and six adult patients admitted to the SICU who required mechanical ventilation support for more than 12 h were included. Ventilator parameters at the initiation of mechanical ventilation support in the SICU were recorded. The LPV strategy was defined as ventilation with a tidal volume of equal or less than 8 ml/kg of predicted body weight plus positive end-expiratory pressure of at least 5 cm H2O. Demographic and clinical data were recorded and analyzed. Results There were 306 patients included in this study. The adherence rate to the LPV strategy was 36.9%. Height was the only factor associated with adherence to the LPV strategy (odds ratio for each cm, 1.10; 95% confidence interval (CI), 1.06-1.15). Cox regression analysis showed that the LPV strategy was associated with increased 90-day mortality (hazard ratio, 1.73; 95% CI, 1.02-2.94). Conclusion The adherence rate to the LPV strategy among patients admitted to the SICU was modest. Further studies are warranted to explore whether the application of the LPV strategy is simply a marker of disease severity or a causative factor for increased mortality.
Collapse
Affiliation(s)
- Annop Piriyapatsom
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ajana Trisukhonth
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Ornin Chintabanyat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Suneerat Kongsayreepong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| | - Chayanan Thanakiattiwibun
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Thailand
| |
Collapse
|
2
|
Mihiretu MM, Bekele E, Ayele K, Asmare L, Bayou FD, Arefaynie M, Tsega Y, Endawkie A, Kebede SD, Kebede N. Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg 2024; 18:2. [PMID: 38218929 PMCID: PMC10787976 DOI: 10.1186/s13037-023-00386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Informed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia. METHODS We searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies' quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version. RESULTS The pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent. CONCLUSION The appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero .
Collapse
Affiliation(s)
- Mengistu Mera Mihiretu
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia.
| | - Ermias Bekele
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kokeb Ayele
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
3
|
Wen J, Liu C, Ding X, Tian Z, Jiang W, Wei X, Liu X. Efficacy and safety of ciprofol (HSK3486) for procedural sedation and anesthesia induction in surgical patients: A systematic review and meta-analysis. Heliyon 2023; 9:e22634. [PMID: 38125496 PMCID: PMC10730721 DOI: 10.1016/j.heliyon.2023.e22634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Ciprofol (HSK3486) is a novel gamma-aminobutyric acid type A (GABAA) receptor agonist that has attracted wide attention because of its lower injection pain and fewer adverse events. We summarized all available evidence and analyzed the efficacy and safety of ciprofol during procedural sedation and anesthesia induction. Methods An electronic search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, Science Direct, the Chinese National Knowledge Infrastructure, Wan Fang Data, and the VIP Chinese Journal Service platform was conducted from inception of databases to March 1, 2023. Risk ratio (RR) and mean difference (MD) with 95 % confidence interval (CI) were used separately for binary categorical and continuous variables. We performed trial sequential analysis and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to judge the certainty of evidence. Results Fifteen randomized controlled trials with 2441 patients were included in this study. Ciprofol showed similar advantages to propofol in terms of induction success rate (RR = 1, 95 % CI = 0.99, 1.01, moderate certainty) and induction time (MD = 3.31, 95 % CI = -0.34, 6.95, low certainty), but did not increase the incidence of adverse events (RR = 0.88, 95 % CI = 0.78, 1.00, very low certainty), such as bradycardia (RR = 0.96, 95 % CI = 0.77, 1.21, high certainty), hypoxia (RR = 0.79, 95 % CI = 0.46, 1.37, p = 0.40, moderate certainty) and other adverse events. Although it may be associated with a longer time to be fully alert (MD = 1.22, 95 % CI = 0.32, 2.12, very low certainty), ciprofol significantly reduced injection pain (RR = 0.15, 95 % CI 0.09, 0.24, low certainty) and may have reduced the incidence of hypotension (RR = 0.77, 95 % CI = 0.63, 0.94, low certainty) and respiratory depression (RR = 0.29, 95 % CI = 0.15, 0.56, moderate certainty). Conclusion Ciprofol and propofol had similar effects on most outcomes. While the time to full alertness may be prolonged, injection pain was significantly reduced, and hypotension and respiratory depression may be reduced compared with propofol. We believe that ciprofol is an effective alternative to intravenous anesthetic agents.
Collapse
Affiliation(s)
- Jiaxuan Wen
- School of Nursing, Weifang Medical University, Weifang, 261053, PR China
| | - Chen Liu
- School of Nursing, Weifang Medical University, Weifang, 261053, PR China
| | - Xueying Ding
- School of Nursing, Weifang University of Science and Technology, Weifang, PR China
| | - Zimeng Tian
- College of Integrated Chinese and Western Medicine, Jining Medical University, 133 Lotus Road, Jining, 272067, Shandong province, PR China
| | - Wenyu Jiang
- School of Public Health, Weifang Medical University, Weifang, 261053, PR China
| | - Xiuhong Wei
- School of Nursing, Weifang Medical University, Weifang, 261053, PR China
| | - Xin Liu
- Department of Neonatology, Weifang People's Hospital, 261000, PR China
| |
Collapse
|
4
|
Wu M, Dai S, Wang R, Yang S. The relationship between uncertainty and acute procedure anxiety among surgical patients in Chinese mainland: the mediating role of resilience. BMC Psychiatry 2023; 23:796. [PMID: 37915033 PMCID: PMC10619271 DOI: 10.1186/s12888-023-05315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Surgery, as one of the main diagnostic and treatment methods, is a routine work in medical settings. Patients undergoing surgery often experience acute procedure anxiety due to uncertainty. There is ample evidence showing that uncertainty is a risk factor for the acute procedure anxiety in surgical patients. However, little is known about the psychological processes mediating this relationship. Therefore, this study aims to evaluate resilience as a mediator of the association between uncertainty and anxiety. METHODS A population-based cross-sectional survey with a convenience sampling method was conducted, involving 243 surgical patients in Jiaxing, Zhejiang province of China was carried out. Relevant data were collected by self-reporting questionnaires, including demographic characteristics questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS-C), Mishel's Illness Uncertainty Scale (MUIS), Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation analysis was employed to examine correlations between various variables. A path model was used to assess the mediation effect of resilience with respect to uncertainty and acute procedure anxiety. RESULTS In the path model, uncertainty have an indirect effect on acute procedure anxiety through resilience. The results suggest that resilience has a mediating role in uncertainty and acute procedure anxiety among surgical patients. CONCLUSIONS These findings call for the development of interventions targeting the role of resilience in effectively predicting and preventing acute procedure anxiety and uncertainty among surgical patients.
Collapse
Affiliation(s)
- Min Wu
- The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
- The graduate school of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Suwan Dai
- The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
- The graduate school of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Rong Wang
- The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| | - Silan Yang
- The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| |
Collapse
|
5
|
Xiong CL, Wang GG, Hanafi WUR. Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study. J Hosp Infect 2023; 139:67-73. [PMID: 37301232 DOI: 10.1016/j.jhin.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.
Collapse
Affiliation(s)
- C L Xiong
- Department of Nosocomial Infection Control, Zhejiang Taizhou Hospital, Zhejiang, China
| | - G G Wang
- Department of Nosocomial Infection Control, Zhejiang Taizhou Hospital, Zhejiang, China
| | - W U-R Hanafi
- Public Health Division, Calaveras County, San Andreas, CA, USA.
| |
Collapse
|
6
|
Nguyen KN, Chuang TI, Wong LT, Chan MC, Chao WC. Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study. BMC Anesthesiol 2023; 23:247. [PMID: 37479965 PMCID: PMC10362554 DOI: 10.1186/s12871-023-02212-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Blood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored. METHODS We enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan's National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables. RESULTS A total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127-1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247-1.811). CONCLUSIONS BAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.
Collapse
Affiliation(s)
- Khoi Nguyen Nguyen
- Division of Hepato-Biliary-Pancreatic Surgery, Chợ Rẫy Hospital, Ho Chi Minh, Vietnam
| | - Tzu-I Chuang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Ting Wong
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Cheng Chan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- Department of post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Big Data Center, Chung Hsing University, Taichung, Taiwan.
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan.
- Taichung Veterans General Hospital, No, 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City, 40705, Taiwan.
| |
Collapse
|
7
|
MacKenzie P, Färber J, Post M, Esser T, Bechmann L, Kropf S, Croner R, Geginat G. Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study. BMC Infect Dis 2023; 23:274. [PMID: 37131139 PMCID: PMC10155433 DOI: 10.1186/s12879-023-08238-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Investigation of risk factors for the presence of vancomycin-resistant enterococci (VRE) in inpatients on surgical wards and associated intensive care units of a German tertiary care hospital. METHODS A single-centre retrospective matched case-control study was performed with surgical inpatients admitted between July 2013 and December 2016. Patients with in-hospital detection of VRE later than 48 h after admission were included and comprised 116 VRE-positive cases and 116 VRE-negative matched controls. VRE isolates of cases were typed by multi-locus sequence typing. RESULTS ST117 was identified as the dominant VRE sequence type. Next to length of stay in hospital or on an intensive care unit and previous dialysis the case-control study revealed previous antibiotic therapy as a risk factor for the in-hospital detection of VRE. The antibiotics piperacillin/tazobactam, meropenem, and vancomycin were associated with the highest risks. After taking into account length of stay in hospital as possible confounder other potential contact-related risk factors such as previous sonography, radiology, central venous catheter, and endoscopy were not significant. CONCLUSIONS Previous dialysis and previous antibiotic therapy were identified as independent risk factors for the presence of VRE in surgical inpatients.
Collapse
Affiliation(s)
- Philip MacKenzie
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jacqueline Färber
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Marius Post
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Torben Esser
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lukas Bechmann
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Siegfried Kropf
- Institute for Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Gernot Geginat
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
- Institut für medizinische Mikrobiologie und Krankenhaushygiene, Otto-von-Guericke University, Leipziger Straße 44, 39120, Magdeburg, Germany.
| |
Collapse
|
8
|
Kebede BF, Tesfa TB, Hiwot AY, Genie YD. Knowledge of surgical informed consent and associated factors among patients undergone obstetric and gynecologic surgery at Jimma Medical Center, Jimma, Ethiopia, 2020: an institutional based cross-sectional study. Perioper Med (Lond) 2023; 12:6. [PMID: 36927837 PMCID: PMC10018955 DOI: 10.1186/s13741-023-00295-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Informed consent is the process whereby a patient makes a voluntary decision about their medical and surgical care with knowledge of the benefits and potential risks. Poor informed consent processes may increase potential for medical errors and malpractice. Little is known of the knowledge of surgical informed consent with regard to their surgical treatment in Ethiopia. Therefore, this study aimed to assess the knowledge of surgical informed consent and associated factors among patients who underwent obstetric and gynecologic surgery at Jimma Medical Center, Jimma, Ethiopia. METHODS AND MATERIALS An institution-based cross-sectional study was conducted from April 1 to May 30, 2020, among 404 women undergo obstetric and gynecologic surgery at Jimma Medical Center. Data were collected through a face-to-face interview using a structured questionnaire. The collected data were coded, entered into Epi data version 3.1, and analyzed using SPSS version 25. Bivariate and multivariate regression analyses were performed to determine the association between an outcome variable and an independent variable. Tables, pie-charts, and texts were used to report the result. RESULTS Of 404 patients sampled, only 372 women were agreed and participated in the study and gave response rate of 92.1%. The respondent satisfaction level (AOR 1.823 (95%CI 1.061-3.134)) and patient to provider relationship (AOR 0.472 (CI 1.217-3.697)) were associated with knowledge of surgical informed consent. CONCLUSION The overall level of knowledge regarding informed consent for surgerywas significantly lower than that of other national and international figures. Patient satisfaction and patientto provider relationships were associated with knowledge of surgical informed consent. Adequate information should provide before surgery to improve patients' knowledge regarding surgical informed consent and to improve the consent process to make it better suited to fit the needs of all patients.
Collapse
Affiliation(s)
- Belete Fenta Kebede
- Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Tsegaw Biyazin Tesfa
- Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | | |
Collapse
|
9
|
Alemu ME, Worku WZ, Berhie AY. Patient satisfaction and associated factors towards surgical service among patients undergoing surgery at referral hospitals in western Amhara Regional State, Ethiopia. Heliyon 2023; 9:e14266. [PMID: 36938460 PMCID: PMC10015238 DOI: 10.1016/j.heliyon.2023.e14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Background Patient satisfaction is a growing concern in all aspects of healthcare. Assessing patient satisfaction has paramount importance for measuring the level of care provided by a health system. The present study aimed to measure the levels of satisfaction among patients undergoing invasive surgery in the referral hospitals of the Western Amhara Regional State. Methods A cross-sectional study design was employed. The data were collected from 422 study participants from February 6 to April 6, 2020. The participants were selected using systematic random sampling technique. Interviewer administered questionnaire and chart review were used for data collection. A binary logistic regression model was used to identify the association between independent variables and patient satisfaction. Level of significance was considered at p value less than 0.05 with 95% confidence level. Result Of the total participants, 290 (68.7%, 95% CI: 64.5-73.5) were found to be satisfied with surgical service. Factors such as age >58 years [AOR = 3.80, 95% CI (1.53-9.46)], 47-58 years [AOR = 2.47, 95%CI (1.07-5.71)], those with no formal education [AOR = 2.73, 95% CI (1.18-6.32)], primary school education [AOR = 3.89, 95%CI (1.65-9.17)] and secondary school education [AOR = 3.37, 95%CI (1.38-8.23)], no history of previous surgical admission [AOR = 2.09, 95%CI (1.07-4.08)], length of stay in the hospital <7 days [AOR = 2.13,95%CI(1.21-3.75)] and elective admission for surgery [AOR = 1.75, 95%CI (1.03-2.99)] were significantly associated with patient satisfaction towards surgical service. Conclusion The proportion of patient satisfaction towards surgical service was found to be low. Factors including age, educational status, history of previous surgical admission, length of stay in the hospital and elective admission for surgery were associated with patient satisfaction. This suggests that healthcare organizations should focus on providing patients with respectful and compassionate patient care approach while paying close attention to how patients are treated.Moreover, in order to provide patient-focused care, health care providers should strengthen their usage of patient characteristics including age, educational level, and type of surgery while developing patient focused care plan.
Collapse
Key Words
- AOR, adjusted odd ratio
- CI, confidence interval
- COR, Crud Odd Ratio
- DMRH, debremarkos referral hospital
- Ethiopia
- FHRH, felege hiwot referral hospital
- GURH, gondar university referral hospital
- GYN&OBS, gynecology and obstetrics ward
- OPHTA, ophthalmology ward
- OW, orthopedic ward
- Patient satisfaction
- SW, surgical ward
- Surgical patients
- Surgical service
- TGRH, tibebe ghion referral hospital
- UK, united kingdom
Collapse
Affiliation(s)
- Mekides Engeda Alemu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Workie Zemene Worku
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Alemshet Yirga Berhie
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Corresponding author.
| |
Collapse
|
10
|
Zhang Z, Zhen K, Li W, Qin X, Qu J, Shi Y, Xu R, Xu Y, Shen D, Du J, Cai C, Zhai Z, Wang C. Validation of the IMPROVE bleeding risk assessment model in surgical patients: Results from the DissolVE-2 Study. Thromb Res 2023; 223:69-77. [PMID: 36708692 DOI: 10.1016/j.thromres.2023.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/29/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION IMPROVE Bleeding Risk Score (BRS) is known to be validated and widely accepted in medical patients. However, its relevance in surgical patients has so far not been explored. External validation of the IMPROVE BRS on bleeding in surgical patients can hopefully improve clinical practice (for surgical patients). METHODS Data from 6986 surgical patients were collected from the DissolVE-2 cohort. The Kaplan-Meier method was used to assess the incidences of major bleeding and any bleeding among surgical patients within 14 days of admission. A cut-off value of BRS ≥7 indicated a higher risk of bleeding. Risk factors associated with major and any bleeding were analysed by the Cox regression method. Model discrimination was evaluated by area under the receiver operator characteristic curves (AUC). Calibration curves and Hosmer-Lemeshow χ2 statistics were used to measure the difference between predicted and observed bleeding risks. RESULTS A total of 6399 surgical patients were included in the final validation cohort. The cumulative incidence rate of any bleeding was 3.9 % (95 % confidence interval [CI], 3.4-4.5), of which the incidence rate of major bleeding was 1.2 % (95 % CI, 0.9-1.6). Among patients with a BRS of ≥7, 16.3 % reported any bleeding, and 26.3 % reported major bleeding. The IMPROVE BRS had a better discriminative power (AUC = 0.69) and excellent goodness of fit (Hosmer-Lemeshow test, P = 0.208) for the prediction of major bleeding events as compared with any bleeding (AUC = 0.55; Hosmer-Lemeshow test, P = 0.004). The calibration plot suggested a more accurate prediction for major bleeding events. Moreover, the IMPROVE BRS had a higher AUC value of 0.83 and better goodness of fit (P = 0.2616) for major bleeding in patients undergoing abdominal surgery than other surgery types. CONCLUSION The IMPROVE BRS is a simple and practical technique that can help in predicting the risk of major bleeding in surgical patients, improving functional and safety outcomes of hospitalized patients with surgery.
Collapse
Affiliation(s)
- Zhu Zhang
- Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.; National Centre for Respiratory Medicine, Beijing, China.; National Clinical Research Centre for Respiratory Diseases, Beijing, China
| | - Kaiyuan Zhen
- Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.; National Centre for Respiratory Medicine, Beijing, China.; National Clinical Research Centre for Respiratory Diseases, Beijing, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Xinyu Qin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.; Department of Respiratory Medicine; Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, China
| | - Yuming Xu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Dan Shen
- Sanofi China, 17-19 Floor, Jing'an Kerry Centre Tower 3, Jing'an District, Shanghai, China
| | - Jingjing Du
- Sanofi China, 17-19 Floor, Jing'an Kerry Centre Tower 3, Jing'an District, Shanghai, China
| | - Changbin Cai
- Sanofi China, 17-19 Floor, Jing'an Kerry Centre Tower 3, Jing'an District, Shanghai, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.; National Centre for Respiratory Medicine, Beijing, China.; National Clinical Research Centre for Respiratory Diseases, Beijing, China..
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.; Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.; WHO Collaboration Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.; National Centre for Respiratory Medicine, Beijing, China.; National Clinical Research Centre for Respiratory Diseases, Beijing, China
| | | |
Collapse
|
11
|
Gillespie BM, Thalib L, Harbeck E, Tobiano G, Kang E, Tobiano S, Tong M, Clark J, Patel B, Chaboyer W. Effectiveness of discharge education for patients undergoing general surgery: A systematic review and meta-analysis. Int J Nurs Stud 2023; 140:104471. [PMID: 36871540 DOI: 10.1016/j.ijnurstu.2023.104471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/24/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed. OBJECTIVE To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes. DESIGN Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life. SETTING Participants were recruited from hospitals. PARTICIPANTS Adult general surgical patients. METHODS MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest. RESULTS Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied. CONCLUSIONS The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes. REGISTRATION PROSPERO CRD42021285392. TWEETABLE ABSTRACT Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
Collapse
|
12
|
Razzaq H, Rao A, Sathananthan S, Majeed A, Dworkin M. Screening tool to improve patient referral to acute surgical care from accident and emergency. Ann R Coll Surg Engl 2023; 105:14-19. [PMID: 35133208 PMCID: PMC9773239 DOI: 10.1308/rcsann.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days. METHODS The first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records. RESULTS In the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively; the overall accuracy was 88.4%. CONCLUSION A large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.
Collapse
Affiliation(s)
- H Razzaq
- Mid and South Essex NHS Foundation Trust, UK
| | - A Rao
- Mid and South Essex NHS Foundation Trust, UK
| | | | | | - M Dworkin
- Mid and South Essex NHS Foundation Trust, UK
| |
Collapse
|
13
|
Biyazin T, Taye A, Belay Y. Patient satisfaction with surgical informed consent at Jimma Medical Center, Ethiopia. BMC Med Ethics 2022; 23:103. [PMID: 36284338 PMCID: PMC9594918 DOI: 10.1186/s12910-022-00841-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Informed consent is a process in which a healthcare provider obtains permission from an individual prior to surgery. Patient satisfaction with the informed consent process is one of the main indicators of healthcare service quality. This study aimed to assess patient satisfaction with surgical informed consent at Jimma Medical Center, Ethiopia, in 2020. Methods A facility-based cross-sectional study was conducted from April 1 to June 30, 2020, at Jimma Medical Center. Face-to-face interviews were conducted using structured questionnaires. A systematic sampling technique was used to select the study participants. The collected data were coded, entered into Epi data version 3.1, and analyzed using SPSS version 25. Bivariate and multivariate regression analyses were performed to determine the association between patient satisfaction and socio-demographic and facility-related factors. In multivariate regression, predictors with a P-value of < 0.05 were considered statistically significant. Results Totally 372 study participants were interviewed with a response rate of 97.8%. Nearly two-fifths (43%) of patients were satisfied with surgical informed consent. Living in an urban area (AOR: 2.279, 95% CI 1.257–4.131), having current referred history (AOR: 1.856, 95% CI 1.033–3.337), consent form version (AOR: 2.076, 95% CI 1.143–3.773), time spent on the provision of informed consent (AOR: 5.227, 95% CI 2.499–10.936) and having better patient-health providers relationship (AOR: 5.419, 95% CI 3.103–9.464) predictors were positively associated with patient satisfaction. Conclusion Patient satisfaction with the surgical informed consent process was relatively low. Therefore, Health care professionals need to emphasize a way of delivering informed consent, patients' needs and obey a standard informed consent to improve patient satisfaction.
Collapse
Affiliation(s)
- Tsegaw Biyazin
- grid.411903.e0000 0001 2034 9160School of Midwifery, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Ayanos Taye
- grid.411903.e0000 0001 2034 9160School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Yeshitila Belay
- grid.411903.e0000 0001 2034 9160School of Nursing, Faculty of Health Science, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
| |
Collapse
|
14
|
Nakadate Y, Nakajima E, Ikemoto K, Oguchi T, Matsukawa T. Anesthetic experience does not reduce accidental dural puncture in surgical patients: a retrospective case-controlled study. BMC Anesthesiol 2022; 22:139. [PMID: 35538409 PMCID: PMC9087935 DOI: 10.1186/s12871-022-01657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background Accidental dural puncture (ADP), which is a complication of epidural anesthesia, still exists and leads to worse outcomes in surgical patients. While residency training is important for epidural competency, it remains unknown whether anesthetic experience reduces ADP in surgical patients. Using an incident reporting system along with anesthetic records, this case-controlled study retrospectively investigated risk factors associated with ADP in surgical patients. Methods Patients who experienced ADP during epidural anesthesia who were registered in the incident reporting system of our institution between April 2012 and March 2019 were enrolled. Patients with ADP were control-matched with those who without ADP in a 1:3 ratio, to compare the potential risk factors and calculated odds ratios (ORs) for ADP. The primary hypothesis was that anesthesiologists’ experience reduces the incidence of ADP. The secondary hypothesis was that there are risk factors for ADP. Between-group differences in anesthesiologists’ experience were compared using the Mann–Whitney U test. Significance was set at P < 0.05. Results Thirty-five patients who experienced ADP were identified from the incident reporting system. These were matched with 69 patients who did not experience ADP. There was no difference in the years of experience of anesthesiologists between the groups that did and did not experience ADP (8 [3–20] vs. 9 [3–18] years, respectively; P = 0.65). Conclusions Having an experienced anesthesiologist did not guarantee the prevention of ADP. Daily individual training and briefings would be needed to reduce the incidence of ADP.
Collapse
Affiliation(s)
- Yosuke Nakadate
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan. .,Department of Anesthesiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Emi Nakajima
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Kodai Ikemoto
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Takeshi Oguchi
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Takashi Matsukawa
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| |
Collapse
|
15
|
Suraarunsumrit P, Pathonsmith C, Srinonprasert V, Sangarunakul N, Jiraphorncharas C, Siriussawakul A. Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country. BMC Geriatr 2022; 22:213. [PMID: 35296258 PMCID: PMC8925052 DOI: 10.1186/s12877-022-02873-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization. Methods Patients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI. Results Two hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15–4.71; P = 0.02). Conclusions POCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization. Trial registration Thai Clinical Trials Registry TCTR20190115001. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02873-3.
Collapse
Affiliation(s)
- Patumporn Suraarunsumrit
- Division of Geriatrics, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | | | - Varalak Srinonprasert
- Division of Geriatrics, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.,Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nipaporn Sangarunakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chalita Jiraphorncharas
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Arunotai Siriussawakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. .,Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| |
Collapse
|
16
|
Wang P, Wang Y, Yuan Z, Wang F, Wang H, Li Y, Wang C, Li L. Venous thromboembolism risk assessment of surgical patients in Southwest China using real-world data: establishment and evaluation of an improved venous thromboembolism risk model. BMC Med Inform Decis Mak 2022; 22:59. [PMID: 35246122 PMCID: PMC8895056 DOI: 10.1186/s12911-022-01795-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 12/20/2022] Open
Abstract
Background Venous thromboembolism (VTE) risk assessment in surgical patients is important for the appropriate diagnosis and treatment of patients. The commonly used Caprini model is limited by its inadequate ability to discriminate between risk stratums on the surgical population in southwest China and lengthy risk factors. The purpose of this study was to establish an improved VTE risk assessment model that is accurate and simple. Methods This study is based on the clinical data from 81,505 surgical patients hospitalized in the Southwest Hospital of China between January 1, 2019 and June 18, 2021. Among the population, 559 patients developed VTE. An improved VTE risk assessment model, SW-model, was established through Logistic Regression, with comparisons to both Caprini and Random Forest. Results The SW-model incorporated eight risk factors. The area under the curve (AUC) of SW-model (0.807 [0.758, 0.853], 0.804 [0.765, 0.840]), are significantly superior (p = 0.001 and p = 0.044) to those of the Caprini (0.705 [0.652, 0.757], 0.758 [0.719, 0795]) on two test sets, but inferior (p < 0.001 and p = 0.002) to Random Forest (0.854 [0.814, 0.890], 0.839 [0.806, 0.868]). In decision curve analysis, within threshold range from 0.015 to 0.04, the DCA curves of the SW-model are superior to Caprini and two default strategies. Conclusions The SW-model demonstrated a higher discriminative capability to distinguish VTE positive in surgical patients compared with the Caprini model. Compared to Random Forest, Logistic Regression based SW-model provided interpretability which is essential in guarantee the procedure of risk assessment transparent to clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01795-9.
Collapse
Affiliation(s)
- Peng Wang
- College of Computer Science, Chongqing University, Chongqing, China.,Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Yao Wang
- Yidu Cloud Technology Inc, Beijing, China
| | - Zhaoying Yuan
- Center for Applied Statistics and School of Statistics, Renmin University of China, Beijing, China
| | - Fei Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Hongqian Wang
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Ying Li
- Medical Big Data Center of Southwest Hospital, Chongqing, China
| | - Chengliang Wang
- College of Computer Science, Chongqing University, Chongqing, China.
| | - Linfeng Li
- Yidu Cloud Technology Inc, Beijing, China.
| |
Collapse
|
17
|
Tsai FC, Chen NL, Gobindram A, Singh PA, Hsu PP, Tan AKL. Efficacy of high flow nasal cannula as an alternative to continuous positive airway pressure therapy in surgical patients with suspected moderate to severe obstructive sleep apnea. Am J Otolaryngol 2022; 43:103295. [PMID: 34922258 DOI: 10.1016/j.amjoto.2021.103295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the efficacy of High flow nasal cannula (HFNC) as an alternative to Continuous Positive Airway Pressure (CPAP) therapy on the first postoperative night in patients with suspected moderate to severe obstructive sleep apnea (OSA). METHODS This is randomised controlled trial conducted in a tertiary hospital which included elective surgical patients with STOP-BANG score of 5 and above. Forty patients were randomised into one of the four postoperative treatment groups: CPAP, or HFNC at three different flow rates (20 L/min, 30 L/min and 40 L/min). The primary outcome measured was the number of recorded drops in baseline SpO2 of >4%. Secondary outcomes measured included the need for supplemental oxygen or other interventions and the total number of hours of usage of the device. Patient satisfaction, preference for device and reasons for their preference were also collected. RESULTS CPAP was used for a significantly fewer number of hours compared to HFNC (at all flow rates) during the first postoperative night. There was no significant difference in the primary outcome or in the requirement for other interventions between the four treatment groups. 73.3% of patients in the HFNC group preferred the use of HFNC to the use of CPAP. Reasons for user preference for HFNC include device comfort, ease of use, reduced noise levels and perception of efficacy. CONCLUSIONS HFNC could be an useful alternative to CPAP as it is not inferior to CPAP in the perioperative management of OSA and is better tolerated.
Collapse
|
18
|
Martín-Fernández M, Heredia-Rodríguez M, González-Jiménez I, Lorenzo-López M, Gómez-Pesquera E, Poves-Álvarez R, Álvarez FJ, Jorge-Monjas P, Beltrán-DeHeredia J, Gutiérrez-Abejón E, Herrera-Gómez F, Guzzo G, Gómez-Sánchez E, Tamayo-Velasco Á, Aller R, Pelosi P, Villar J, Tamayo E. Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality. Crit Care 2022; 26:4. [PMID: 35000603 PMCID: PMC8744280 DOI: 10.1186/s13054-021-03875-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery. METHODS We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. RESULTS In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39-0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. CONCLUSIONS Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections.
Collapse
Affiliation(s)
- Marta Martín-Fernández
- Department of Medicine, Toxicology and Dermatology, University of Valladolid, Valladolid, Spain
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Heredia-Rodríguez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | | | - Mario Lorenzo-López
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rodrigo Poves-Álvarez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - F. Javier Álvarez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pharmacology, University of Valladolid, Valladolid, Spain
| | - Pablo Jorge-Monjas
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Eduardo Gutiérrez-Abejón
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pharmacology, University of Valladolid, Valladolid, Spain
| | - Francisco Herrera-Gómez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gabriella Guzzo
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Esther Gómez-Sánchez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Tamayo-Velasco
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rocío Aller
- Department of Medicine, Toxicology and Dermatology, University of Valladolid, Valladolid, Spain
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Department of Gastroenterology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, 4th Floor-South Wing, 35019 Las Palmas de Gran Canaria, Spain
- Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toronto, ON Canada
| | - Eduardo Tamayo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Surgery, University of Valladolid, Valladolid, Spain
| |
Collapse
|
19
|
Wang X, Naito Y, Nakatani H, Ida M, Kawaguchi M. Prevalence of undernutrition in surgical patients and the effect on length of hospital stay. J Anesth 2021. [PMID: 34782947 DOI: 10.1007/s00540-021-03013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Low nutritional status is common among surgical patients. A low nutrition profile is related to muscle weakness and immune suppression, which may be associated with negative outcomes. In this study, we evaluated the prevalence of low nutrition and assessed the relationship between nutritional status and length of hospital stay in surgical patients. METHODS The study participants were patients who underwent abdominal surgery between 2016 and 2018 at our hospital. The Mini Nutritional Status Short-Form score and patient demographics, including current medical status, were extracted from the medical records. Data on anesthesia time, blood loss, and use of epidural anesthesia were also recorded. The primary study outcome was the difference in length of hospitalization from the standard duration (hospitalization = actual length of hospitalization-standard length of hospitalization). RESULTS Eight hundred and thirty five patients met the inclusion criteria. Their nutritional status was classified as normal (59.0%), at risk (29.6%), or malnutrition (11.4%). Linear regression analysis revealed that nutritional status, serum albumin level, and anesthesia time were associated with the length of hospital stay. CONCLUSION Our results suggest that a low nutrition profile before surgery is associated with a prolonged hospital stay.
Collapse
|
20
|
Schmidt G, Edinger F, Koch C, Wolff M, Biehl C, Hörbelt R, Sander M. Ultrasound-accelerated thrombolysis in high-risk perioperative pulmonary embolism: two case reports and review of literature. Perioper Med (Lond) 2021; 10:35. [PMID: 34657630 DOI: 10.1186/s13741-021-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/26/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Treatment of high-risk pulmonary embolism (PE) in perioperative patients remains challenging. Systemic thrombolysis is associated with a high risk of major bleedings and intracranial haemorrhage. High mortality rates are reported for open pulmonary embolectomy. Therefore, postoperative surgical patients may benefit substantially from catheter-directed ultrasound-accelerated thrombolysis (USAT). Case presentation We report two cases of high-risk perioperative PE. Both patients developed severe haemodynamic instability leading to cardiac arrest. After the implantation of a veno-arterial extracorporeal membrane oxygenation (ECMO), they were both successfully treated with USAT. Adequate improvement of right ventricular function was achieved; thus, ECMO could be successfully weaned after 3 and 4 days, respectively. Both patients showed favourable outcomes and could be discharged to rehabilitation. Conclusion Current guidelines on treatment of PE offer no specific therapies for perioperative patients with high-risk PE. However, systemic thrombolysis is often excluded due to the perioperative setting and the risk of major bleeding. Catheter-directed thrombolysis was shown to utilise less thrombolytic agent while obtaining comparable thrombolytic effects. The risk for major bleeding (including intracranial haemorrhage) is also significantly lowered. Until further trials determining the value of adopted treatment strategies of high-risk PE in perioperative patients are available, USAT should be considered in similar cases.
Collapse
|
21
|
Dai J, Yang Z, Wu C. The reliability and validity of the Scott Triggers for patients in China undergoing gastrointestinal surgery. Asian J Surg 2021; 44:1343-1344. [PMID: 34462196 DOI: 10.1016/j.asjsur.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Scott Triggers is designed to identify potential surgical patients at risk for development of pressure injuries. But it has not been validated for sensitivity and positive predictive value to date. This study aimed to evaluate the reliability and validity of the Scott Triggers for the gastrointestinal surgery patients in China. METHODS 447 gastrointestinal surgery patients were enrolled by convenience sampling and investigated by Scott Triggers from March to November 2019. RESULTS 8 patients (1.780%) develop pressure injuries. The Cronbach's alpha was 0.701 and the interrater reliability was 0.915. The content validity of each item of Scott Triggers ranged from 0.667 to 1.0 and the content validity of the whole scale was 0.832, which showed a significant positive relationship and good internal consistent validity. The accumulative variance contribution ratio of common factor was 53.194%. Pearson correlation between Scott Triggers and 3S intraoperative risk assessment scale was -0.708 (P < 0.001). The Youden index was 0.374, the optimal predictive threshold of Scott Triggers was 5.5, the area under receiver operating characteristic (ROC) curve was 0.762, the sensitivity was 0.875, the specificity was 0.499, the positive predictive value was 0.027, and the negative predictive value was 0.996. CONCLUSION Scott Triggers shows good reliability, validity, and predictive validity in this study, which can be used to assess the risk of stress injury in surgical patients. However, the body mass index needs to be taken into account in further study.
Collapse
Affiliation(s)
- Jinghua Dai
- Department of Anesthesia Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Zhaoxia Yang
- Intensive Care Unit, The Fourth People's Hospital of Zhenjiang, Zhenjiang, 212001, China
| | - Chunmei Wu
- Department of Anesthesia Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China.
| |
Collapse
|
22
|
Nankam WLN, Kwetche PRF, Tazemda-Kuitsouc GB, Chouna GJD, Tekam JM. Hospitalization and colonization by methicillin-resistant Staphylococcus aureus in the surgical department of 03 health facilities in the Ndé division, West-Cameroon. Ann Clin Microbiol Antimicrob 2021; 20:48. [PMID: 34281527 PMCID: PMC8290526 DOI: 10.1186/s12941-021-00451-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Commensal flora colonization during hospitalization by bacteria is the first step for nosocomial infections while antibiotic resistance reduces therapeutic options. In aim to control this phenomenon, we initiated this study to describe the impact of hospitalization on colonization by methicillin-resistant Staphylococcus aureus in the surgical department of 03 health facilities in the Ndé division, West-Cameroon. Methods This study was carried out on patients admitted for surgery in 03 health facilities of the Ndé division, West-Cameroon (District Hospital of Bangangté, Protestant Hospital of Bangwa and Cliniques Universitaires des Montagnes). After obtaining ethical clearance and authorizations, nasal swabs were performed at admission and discharge, with the aim of isolating bacteria and performing their antibiotic susceptibility tests. Informations on each participant's antibiotic therapy were recorded. Laboratory investigations were carried out according to standard protocols (CASFM, 2019). Results The most commonly used antibiotics were β-lactams. A total of 104 nasal swabs were performed on 52 patients who agreed to participate to the study. From the analysis, 110 (57 at admission versus 53 at discharge) Staphylococcus isolates were obtained. Overall, susceptibility testing showed that antibiotic resistance rates were higher at discharge than at admission; with significant differences between the susceptibility profiles obtained at admission and discharge for β-lactams and not significant for fluoroquinolones and aminoglycosides. Globally, frequency of nasal carriage of methicillin-resistant Staphylococcus aureus at discharge 16 (30.77%) was significantly higher than at admission 07 (13.46%) with Chi-2 = 4.52 and p = 0.0335. Conclusion The high rates of antibiotic resistance of bacteria isolated at discharge compared to those isolated at admission obtained in the present investigation, highlights the important role that hospitalization plays in the selection and dissemination of methicillin-resistant Staphylococcus aureus and colonization by these bacteria in health structures of Ndé division. As a result, further investigations to find the factors that promote this phenomenon should be carried out.
Collapse
Affiliation(s)
- William Lelorel Nguekap Nankam
- School of Medical Biology, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon. .,Laboratory of Microbiology, Université Des Montagnes Teaching Hospital, Bangangté, Cameroon.
| | - Pierre René Fotsing Kwetche
- School of Medical Biology, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon.,Laboratory of Microbiology, Université Des Montagnes Teaching Hospital, Bangangté, Cameroon.,School of Pharmacy, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon.,School of Human Medicine, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon
| | - Gildas Boris Tazemda-Kuitsouc
- School of Medical Biology, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon.,School of Human Medicine, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon.,Réseau Des Hygiénistes du Cameroun, Bangangté, Cameroon
| | - Golda Joyce Djeutsa Chouna
- School of Medical Biology, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon.,Laboratory of Microbiology, Université Des Montagnes Teaching Hospital, Bangangté, Cameroon
| | - Jean Michel Tekam
- School of Pharmacy, Higher Institute of Health Sciences, Université Des Montagnes, Bangangté, Cameroon
| |
Collapse
|
23
|
Lilley EJ. Navigating Difficult Conversations: Breaking Bad News and Exploring Goals of Care in Surgical Patients. Surg Oncol Clin N Am 2021; 30:535-543. [PMID: 34053667 DOI: 10.1016/j.soc.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Surgeons who provide care for patients with cancer are sometimes tasked with challenging conversations. Approaching difficult communications using a structured approach for delivering difficult news and exploring goals of care can help surgeons provide support to patients and their families.
Collapse
Affiliation(s)
- Elizabeth J Lilley
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, 75 Francis St, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
24
|
Abraham J, Meng A, Sona C, Wildes T, Avidan M, Kannampallil T. An observational study of postoperative handoff standardization failures. Int J Med Inform 2021; 151:104458. [PMID: 33932762 DOI: 10.1016/j.ijmedinf.2021.104458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient handoffs from an operating room (OR) to an intensive care unit (ICU) require precise coordination among surgical, anesthesia, and critical care teams. Although several standardized handoff strategies have been developed, their sustainability remains is poor. Little is known regarding factors that impede handoff standardization. PURPOSE Our objectives are three-fold: (1) highlight compliance failures with standardized handoffs; (2) identify factors contributing to compliance failures; and (3) develop guidelines for sustainable handoff interventions and processes. METHODS We used ethnographic data collection methods-general observations, handoff shadowing, and semi-structured clinician interviews-with 84 participants from OR, ICU, and telemedicine teams at a large academic medical center. We conducted thematic analysis supported by inductive and deductive coding using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. RESULTS Post-operative handoffs can be characterized into four phases: pre-transfer preparation, transfer and setup, report preparation and delivery, and post-transfer care. We identified compliance failures with standardized handoff protocols and associated risk factors within the OR-ICU work system including limited teamwork, absence of handoff-specific tools, and poor clinician buy-in. To improve handoffs, clinicians provided suggestions for developing collaborative Electronic Health Record (EHR)-integrated handoff tools and re-engineering the handoff process. CONCLUSIONS Compliance failures are prevalent in all handoff phases, leading to poor adherence with standardization. We propose theoretically grounded guidelines for designing "flexibly standardized" bundled handoff interventions for ensuring care continuity in OR to ICU transitions of care.
Collapse
|
25
|
Elsaid RM, Namrouti AS, Samara AM, Sadaqa W, Zyoud SH. Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine. BMC Surg 2021; 21:177. [PMID: 33794852 PMCID: PMC8017875 DOI: 10.1186/s12893-021-01172-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.
Collapse
Affiliation(s)
- Reem M Elsaid
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine
| | - Ashraqat S Namrouti
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine
| | - Ahmad M Samara
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine
| | - Wael Sadaqa
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine
- Department of Anesthesia and Intensive Care, An-Najah National University Hospital, 44839, Nablus, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, 44839, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, 44839, Nablus, Palestine.
| |
Collapse
|
26
|
Brima N, Sevdalis N, Daoh K, Deen B, Kamara TB, Wurie H, Davies J, Leather AJM. Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project. Pilot Feasibility Stud 2021; 7:33. [PMID: 33504369 PMCID: PMC7839195 DOI: 10.1186/s40814-021-00768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. METHODS This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory 'Theory of Change' process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases-(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention's effectiveness For improving nursing in this pilot setting. DISCUSSION We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. TRIAL REGISTRATION Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.
Collapse
Affiliation(s)
- Nataliya Brima
- King's Centre for Global Health & Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Daoh
- Connaught Teaching Hospital Complex, Freetown, Sierra Leone
| | - B Deen
- Connaught Teaching Hospital Complex, Freetown, Sierra Leone
| | - T B Kamara
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Haja Wurie
- Faculty of Nursing, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J M Leather
- King's Centre for Global Health & Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
27
|
Ford C, Robertson M. Care of the surgical patient-part 2: oral anticoagulants. Br J Nurs 2020; 29:1242-1246. [PMID: 33242277 DOI: 10.12968/bjon.2020.29.21.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Part two of this series on the care of the surgical patient introduces readers to some of the additional risks associated with patients who are undergoing surgery and taking oral anticoagulants. It explores the use of vitamin K antagonists and heparin. Some of the management strategies and additional considerations that need to be addressed during the perioperative care continuum will also be discussed.
Collapse
Affiliation(s)
- Claire Ford
- Lecturer, Adult Nursing, Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne
| | - Matthew Robertson
- Graduate Tutor ODP, Department of Health and Life Sciences, Northumbria University, Newcastle upon Tyne
| |
Collapse
|
28
|
Zhou Z, Wang Y, Niu Y, He Z, Huang M, Zhou Y, Lv W, Hu J. How we assess the perioperative anxiety of surgical patients with pulmonary nodules: the revision of state-trait anxiety inventory. J Cardiothorac Surg 2020; 15:324. [PMID: 33115530 PMCID: PMC7592361 DOI: 10.1186/s13019-020-01338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The aim of the study was to develop a short form of State-Trait Anxiety Inventory (STAI) and calculate the norms for the assessment of anxiety in surgical patients in mainland China. METHODS Patients who were scheduled to carry out pulmonary surgery in our department were included. The sinicized 40-item STAI Form-Y was used to assess the anxiety on the surgery eve. Then the coefficient of variation, coefficient of correlation, stepwise regression analysis, principal component analysis, and structural equation model were successively to filter the items. The reliability and validity of the revised STAI was estimated and the norms were computed. RESULTS 445 intact replies were collected. A 13-item STAI with 6 items in state subscale and 7 items in trait subscale produced similar scores with the full version of STAI. The Cronbach alpha coefficients for the state and trait subscales were 0.924 and 0.936, respectively. The determinant coefficients were 0.781 and 0.822, respectively. Moreover, the norms of both state subscale and trait subscale are provided according to the age and gender. CONCLUSIONS The revised short form of STAI has good reliability and validity. It is likely to be more acceptable by reducing the fatigue effects, and is suitable for follow-up study on the assessment and intervention of perioperative anxiety of surgical patients with pulmonary nodules.
Collapse
Affiliation(s)
- Zhenyu Zhou
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Ying Wang
- Operation Room, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yuequn Niu
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhehao He
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Manli Huang
- Department of Psychiatry, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yuqiong Zhou
- Operation Room, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
| |
Collapse
|
29
|
Shi X, Xu M, Yu X, Lu Y. Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study. BMC Anesthesiol 2020; 20:153. [PMID: 32552781 PMCID: PMC7301460 DOI: 10.1186/s12871-020-01072-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Peripheral perfusion index (PPI) is an indicator reflecting perfusion. Patients undergoing long time surgeries are more prone to hypoperfusion and increased lactate. Few studies focusing on investigating the association between PPI and surgical patients’ prognoses. We performed this study to find it out. Methods From January 2019 to September 2019, we retrospected all surgical patients who were transferred to ICU, Xinyang Central hospital, Henan province, China. Inclusive criteria: age ≥ 18 years old; surgical length ≥ 120 min. Exclusive criteria: died in ICU; discharging against medical advice; existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; severe liver dysfunction. We defined “prolonged ICU stay” as patients with their length of ICU stay longer than 48 h. According to the definition, patients were divided into two groups: “prolonged group” (PG) and “non-prolong group” (nPG). Baseline characteristics, surgical and therapeutic information, ICU LOS, SOFA and APACHE II were collected. Besides we gathered data of following parameters at 3 time points (T0: ICU admission; T1: 6 h after admission; T2: 12 h after admission): mean artery pressure (MAP), lactate, heart rate (HR), PPI and body temperature. Data were compared between the 2 groups. Multivariable binary logistic regression and ROC (receiver operating characteristic) curves were performed to find the association between perfusion indictors and ICU LOS. Results Eventually, 168 patients were included, 65 in PG and 103 in nPG. Compared to nPG, patients in PG had higher blood lactate and lower PPI. PPI showed significant difference between two groups earlier than lactate (T0 vs T1). The value of PPI at two time points was lower in PG than nPG(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001). Increased lactateT1(OR 3.216; 95% CI 1.253–8.254, P = 0.015) and decreased PPIT1 (OR 0.070; 95% CI 0.016–0.307, P < 0.001) were independently associated with prolonged ICU stay. The area under ROC of the PPIT1 for predicting ICU stay> 48 h was 0.772, and the cutoff value for PPIT1 was 1.35, with 83.3% sensitivity and 73.8% specificity. Conclusions PPI and blood lactate at T1(6 h after ICU admission) are associated with ICU LOS in surgical patient. Compared to lactate, PPI indicates hypoperfusion earlier and more accurate in predicting prolonged ICU stay.
Collapse
Affiliation(s)
- Xinge Shi
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Ming Xu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Xu Yu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Yibin Lu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China.
| |
Collapse
|
30
|
Abstract
A common fallacy prevalent in surgical culture is for surgical intervention and palliation to be regarded as mutually exclusive or sequential strategies in the trajectory of surgical illness. Modern surgeons play a complex role as both providers and gatekeepers in meeting the palliative needs of their patients. Surgical palliative care is ideally delivered by surgical teams as a component of routine surgical care, and includes management of physical and psychosocial symptoms, basic communication about prognosis and treatment options, and identification of patient goals and values. Specialty palliative care services may be accessed through a through a variety of models.
Collapse
Affiliation(s)
- Ana Berlin
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 5-562, New York, NY 10032, USA; Department of Medicine, Division of Hematology/Oncology, Adult Palliative Medicine Service, Columbia University Medical Center, New York, NY, USA.
| | - Teresa Johelen Carleton
- Tucson Medical Center Palliative Care, Tucson Medical Center, 5301 E. Grant Road, Tucson, AZ 85712, USA; University of Arizona Phoenix, Phoenix, AZ, USA
| |
Collapse
|
31
|
Taye M, Daka D, Amsalu A, Hussen S. Magnitude of hepatitis B and C virus infections and associated factors among patients scheduled for surgery at Hawassa University comprehensive specialized Hospital, Hawassa City, southern Ethiopia. BMC Res Notes 2019; 12:412. [PMID: 31307538 PMCID: PMC6632215 DOI: 10.1186/s13104-019-4456-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022] Open
Abstract
Objective The aim of this study was to assess the magnitude of HBV and HCV infection and its associated factors among surgical patients at Hawassa University comprehensive specialized Hospital Hawassa City, southern Ethiopia. Result In this study, the prevalence of HBsAg and Anti-HCV among patients scheduled for surgery were 9% and 5.5%, respectively. Patients who practiced multiple sexual partner (AOR = 2.58, CI 1.18–5.61), dental procedure (AOR = 4.20, CI 1.87–9.55) and blood transfusion (AOR = 3.84, CI 1.27–11.65) had higher odds of HBV infection and those who had history of surgical procedure (AOR = 6.05: 95% CI 1.59–23.04) and dental procedure (AOR = 3.70: 95% CI 1.40–9.77) had higher odds of HCV infection. Electronic supplementary material The online version of this article (10.1186/s13104-019-4456-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Meseret Taye
- School of Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Deresse Daka
- School of Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Amsalu
- School of Biomedical and Laboratory Sciences, Gondar University, Gondar, Ethiopia
| | - Siraj Hussen
- School of Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| |
Collapse
|
32
|
Abrha MW, Seid O, Gebremariam K, Kahsay A, Weldearegay HG. Nutritional status significantly affects hospital length of stay among surgical patients in public hospitals of Northern Ethiopia: single cohort study. BMC Res Notes 2019; 12:416. [PMID: 31307530 DOI: 10.1186/s13104-019-4451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed to assess the effect of nutritional status on length of hospital stay in Northern Ethiopia. RESULT Institutional based prospective cohort study was conducted among 324 admitted surgical patients. Length of hospital stay were significantly associated with duration of disease (Adjusted Hazard Ratio (AHR) = 3.7,95% Confidence interval (CI):2.35-5.82), history of surgery (AHR = 1.4, 95% CI 1.40, 95% CI 1.17-1.86), nutritional status (Body Mass Index (AHR = 1.38, 95% CI 1.28-1.51), Mid Upper Arm Circumference (AHR = 1.29, 95% CI 1.04-1.62)) and individual diet diversity score (AHR = 2.64, 95% CI 1.14-6.14). Screening of patients for malnutrition at admission and provision of dietary supplements based on their nutritional status is recommended.
Collapse
|
33
|
Young-Wolff KC, Adams SR, Fogelberg R, Goldstein AA, Preston PG. Evaluation of a Pilot Perioperative Smoking Cessation Program: A Pre-Post Study. J Surg Res 2019; 237:30-40. [PMID: 30694789 DOI: 10.1016/j.jss.2018.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/26/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical clinic and perioperative settings are critical touchpoints for treating smoking, yet health care systems have not typically prioritized smoking cessation among surgical patients. We evaluated the implementation of a pilot smoking cessation intervention integrated into standard perioperative care. MATERIALS AND METHODS English-speaking adult smokers undergoing elective surgery in Kaiser Permanente San Francisco before (2015) and after (2016-2017) the implementation of a smoking cessation intervention were included. Provider outcomes included counseling referrals, cessation medication orders (between surgery scheduling and surgery), and preoperative carbon monoxide testing. Patient outcomes included counseling and medication use, smoking status at surgery and 30 d after discharge, and surgical complications. Multivariable logistic regression analyses examined pre-to-post intervention changes in outcomes using electronic health record data and 30-d postdischarge telephone surveys. RESULTS The sample included 276 patients (70% male; 59% non-Hispanic white; mean age = 50 y). There were significant pre-to-post increases in tobacco cessation counseling referrals (3% to 28%, adjusted odds ratio [AOR] = 11.12, 95% confidence interval [CI] = 3.78-32.71) and preoperative carbon monoxide testing (38% to 50%, AOR = 1.83, 95% CI = 1.10-3.06). At ∼30 d after discharge, patients in the postintervention period were more likely to report smoking abstinence in the previous 7 d (24% pre, 44% post; AOR = 2.39, 95% CI = 1.11-5.13) and since hospital discharge (18% pre, 39% post; AOR = 3.20, 95% CI = 1.42-7.23). Cessation medication orders and patient use of counseling and medications increased, whereas surgical complications decreased, but pre-to-post differences were not significant. CONCLUSIONS A perioperative smoking cessation program integrated into standard care demonstrated positive smoking-related outcomes; however, larger studies are needed to evaluate the effectiveness of these programs.
Collapse
Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Renee Fogelberg
- Richmond Medical Center, Kaiser Permanente Northern California, Richmond, California
| | - Alison A Goldstein
- Regional Offices, Kaiser Permanente Northern California, Oakland, California
| | - Paul G Preston
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, California
| |
Collapse
|
34
|
Antonioli P, Formaglio A, Gamberoni D, Bertoni L, Perrone P, Stefanati A, Libanore M, Cultrera R, Gabutti G. Hospital discharge in patients at risk of surgical site infection: antimicrobial stewardship at Ferrara University Hospital, Italy. J Prev Med Hyg 2018; 59:E139-E144. [PMID: 30083621 PMCID: PMC6069401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The appropriate use of antibiotics is a global priority in order to avoid antibiotic resistance. Up to 50% of antibiotics usage in hospital is inappropriate (e.g. prolonged surgical prophylaxis, "defensive medicine" approach). In 2015, at the Ferrara University Hospital, an antimicrobial stewardship intervention to reduce antimicrobial prescription at the time of hospital discharge in patients at risk of surgical site infection was implemented. This programme included: update meetings for health professionals, focused meetings for critical wards, reviews of some surgical prophylaxis protocols, recommendations to reduce broad-spectrum antimicrobials use, and planning of an audit. The purpose of this study has been to evaluate the effect of this antimicrobial stewardship programme. METHODS To evaluate the effect of this intervention, a study has been carried out including inpatients in surveillance for surgical site infection who had surgery during the last quarter of 2014 (pre-intervention group; 461 patients) and of 2015 (post-intervention group; 532 patients). RESULTS The proportion of patients with prescription of at least one antimicrobial at discharge decreased from 33% to 24.4% (p = 0.002). The most prescribed categories of antimicrobials in both groups were the combination of penicillins with beta-lactamase inhibitors (with prescription rate reduced from 21.9% to 18%; p = 0.13) and fluoroquinolones (from 8.2% to 3.2%; p < 0.001). CONCLUSIONS This statistically significant reduction in antimicrobial prescription after the intervention was registered without a change in surgical site infections rate (from 3.5% to 3.2%; p = 0.08). Therefore, this intervention was effective in reducing the antimicrobial prescription at discharge, without affecting patients' safety.
Collapse
Affiliation(s)
- P. Antonioli
- Department of Hospital Hygiene & Healthcare Associated Infection Risk Management, Coordination of Clinical Health Promotion Activities, Hospital Health Medical Management, Ferrara University Hospital, Ferrara, Italy
| | - A. Formaglio
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - D. Gamberoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - L. Bertoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - P. Perrone
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - A. Stefanati
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
| | - M. Libanore
- Hospital Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - R. Cultrera
- University Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - G. Gabutti
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
| |
Collapse
|
35
|
Krampe H, Salz AL, Kerper LF, Krannich A, Schnell T, Wernecke KD, Spies CD. Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial. BMC Psychiatry 2017; 17:417. [PMID: 29284443 DOI: 10.1186/s12888-017-1579-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care. METHODS The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only. RESULTS Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness. CONCLUSIONS Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01357694.
Collapse
|
36
|
Kim S, Kim JJ, Oh J, Park J, Park JY. Delirium characteristics and outcomes in medical and surgical lnpatients: A subgroup analysis. J Crit Care 2017; 43:156-162. [PMID: 28903083 DOI: 10.1016/j.jcrc.2017.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/20/2017] [Accepted: 08/05/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Persistent delirium can negatively affect patients, increase healthcare costs, and extend the length of hospital stays. This investigation was undertaken to explore associations between patient characteristics and delirium outcomes. MATERIALS AND METHODS Intensive care unit (ICU) and medical and surgical ward inpatients for whom psychiatric consultation was requested for delirium were included in this study. Delirium screening and ongoing assessments were conducted using the Confusion Assessment Method for ICU patients. RESULTS Postoperative delirium developing as a secondary complication following surgery was found to be of significantly longer duration and associated with greater length of hospitalization compared with postoperative delirium attributable to surgery and delirium in medical patients. Medical patients with delirium had lower delirium recovery rates at discharge compared with surgical patients. CONCLUSIONS The findings that patient type and timing of postoperative delirium are associated with differential delirium outcomes suggest that targeted screening and intervention approaches may be needed. Medical patients were more likely to be discharged before recovery from delirium compared with surgical patients. Differences in underlying chronic medical conditions may account for the observed differences in discharge condition between medical and surgical patients with delirium.
Collapse
Affiliation(s)
- Sungmin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Jin Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jooyoung Oh
- Department of Biomedical Science and Engineering, Institute of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Jaesub Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea.
| | - Jin Young Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea.
| |
Collapse
|
37
|
Šuljagić V, Miljković I, Starčević S, Stepić N, Kostić Z, Jovanović D, Brusić-Renaud J, Mijović B, Šipetić-Grujičić S. Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case-control study. Antimicrob Resist Infect Control 2017; 6:31. [PMID: 28360993 PMCID: PMC5369004 DOI: 10.1186/s13756-017-0188-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital. METHODS Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI. RESULTS The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93-58.4), the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41-6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18-4.39). Patients with HA CDI had significantly higher in-hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84-43.43). CONCLUSIONS CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.
Collapse
Affiliation(s)
- Vesna Šuljagić
- Department of Nosocomial Infections Control, Military Medical Academy, 11 000 Belgrade, Serbia.,Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia
| | - Ivan Miljković
- Institute of Epidemiology, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Srđan Starčević
- Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.,Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Nenad Stepić
- Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.,Clinic for Plastic Surgery and Burns, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Zoran Kostić
- Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.,Clinic for General Surgery, Military Medical Academy, 11 000 Belgrade, Serbia
| | - Dragutin Jovanović
- Institute of Microbiology Military Medical Academy, 11 000 Belgrade, Serbia
| | | | - Biljana Mijović
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, Republic of Srpska, Bosnia and Herzegovina
| | - Sandra Šipetić-Grujičić
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
38
|
Silva JM, Rocha HMC, Katayama HT, Dias LF, de Paula MB, Andraus LMR, Silva JMC, Malbouisson LMS. SAPS 3 score as a predictive factor for postoperative referral to intensive care unit. Ann Intensive Care 2016; 6:42. [PMID: 27130426 PMCID: PMC4851671 DOI: 10.1186/s13613-016-0129-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 03/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. However, some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this. METHODS The study included patients undergoing intermediate-risk surgery with preoperative indication for ICU but who were taken to the ward postoperatively, because they appeared to be responding well. However, they required late ICU admission. ICU care and preoperative SAPS 3 score were evaluated. Palliative surgeries and patients readmitted to ICU were excluded. RESULTS The study included 100 patients, 27 % of whom had late postoperative admission to the ICU. The preoperative SAPS 3 score was higher (45.4 ± 7.8 vs. 35.9 ± 7.4, P < 0.001) in patients who required delayed admission to the ICU postoperatively. Furthermore, they had undergone longer surgery (4.2 ± 1.9 vs. 2.7 ± 1.5 h, P < 0.001), and a greater proportion were gastrointestinal surgeries (14.8 vs. 5.5 %, P = 0.03) and intraoperative transfusion (18.5 vs. 5.5 % P = 0.04). In multivariate analysis, preoperative SAPS 3 and surgery duration independently predicted postoperative ICU admission, respectively (OR 1.25; 95 % CI 1.1-1.4 and OR 3.33; 95 % CI 1.7-6.3). CONCLUSION The identification of high-risk surgical patients is essential for proper treatment; time of surgery and preoperative SAPS 3 seem to provide a useful indication of risk and may help better to characterize patients undergoing intermediate-risk surgery that demand ICU care.
Collapse
Affiliation(s)
- João M. Silva
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
- Anaesthesiology Department, Hospital das Clinicas SP-FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP 05403-000 Brazil
| | - Helder Marcus Costa Rocha
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Henrique Tadashi Katayama
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Leandro Ferreira Dias
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Mateus Barros de Paula
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Leusi Magda Romano Andraus
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Jose Maria Correa Silva
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
| | - Luiz Marcelo Sá Malbouisson
- Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A–Vila Clementino, São Paulo, SP 04039-901 Brazil
- Anaesthesiology Department, Hospital das Clinicas SP-FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP 05403-000 Brazil
| |
Collapse
|
39
|
Shafipour V, Ramezanpour E, Gorji MAH, Moosazadeh M. Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis. Electron Physician 2016; 8:3170-3176. [PMID: 28070249 PMCID: PMC5217808 DOI: 10.19082/3170] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A pressure ulcer is a serious safety issue in healthcare systems. The patient's rate of infection with an ulcer, especially a postoperative ulcer, is critical, as it is dictated by factors such as being in a fixed position during surgery, the type of anesthesia used, the duration of surgery, and patient-related factors. The present study was conducted to carry out a systematic assessment of the prevalence of a postoperative pressure ulcer and to find its general prevalence using a meta-analysis. METHODS The researchers searched databases, including PubMed, Google Scholar, Scopus, Science Direct, the Thomson Reuters' Web of Science (WOS). For English articles published online between January 2000 and October 2015 on the subject of a pressure ulcer, a total of 19 articles were ultimately selected based on the study inclusion criteria. Then results were analyzed in Stata-11. RESULTS The 19 articles qualified for entering the meta-analysis examined a total of 9527 patients. The studies estimated the general prevalence of a postoperative pressure ulcer as 18.96% (CI 95%: 15.3-22.6); the prevalence by gender was reported as 10.1% (CI 95%: 7.2-13.01) in men and 12.8% (CI 95%: 8.3-17.2) in women. Stage 1 ulcer had a 17.02% prevalence (CI 95%: 11.04-22.9), stage 2 a 6.7% prevalence (CI 95%: 3.8-9.7), stage 3 a 0.9% prevalence (CI 95%: 0.2-1.6), and stage 4 a 0.4% (CI 95%: -0.05-0.8) prevalence. CONCLUSION The prevalence of a postoperative pressure ulcer is high among the entire population; however, it is still higher in women than in men. The prevalence of a stage 1 ulcer is higher than the prevalence of the other stages of an ulcer.
Collapse
Affiliation(s)
- Vida Shafipour
- Ph.D., Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ensieh Ramezanpour
- M.Sc. of Critical Care Nursing, Student's Research Committee, Nasibeh Nursing & Midwifery Faculty Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ali Heidari Gorji
- Ph.D., Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Ph.D. of Epidemiology, Assistant Professor, Health Science Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
40
|
Gil Bona J, Pascual Bellosta A, Ojeda Cabrera J, Ortega Lucea S, Muñoz Rodríguez L, Martínez Ubieto J, Pérez-Navarro G. [Analysis of factors conditioning admission at the critical care unit of surgical patients. Prospective study of 764 patients operated for 1 year at a university and reference hospital]. ACTA ACUST UNITED AC 2014; 62:72-80. [PMID: 25024002 DOI: 10.1016/j.redar.2014.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess what factors determine the income of surgical patients in critical care unit after surgery. MATERIAL AND METHODS It included a survey of the 10% of all patients operated by the services of General Surgery, Thoracic Surgery, Maxillofacial Surgery, Vascular Surgery, Urology and Otolaryngology during 2012. We performed a prospective, observational study. Pre-, intra-, and post-operative variables were analyzed. Comparisons were made between patients operated under elective and emergency surgery, and between patients admitted in critical care and admitted directly in the ward, using χ(2) of Pearson correlation with a confidence interval of 95%. RESULTS Seven hundred and sixty-four patients were included into the study, 304 were admitted in critical care after surgery and 460 were admitted in the ward. The medical history showed a statistically significant association with intensive care unit admission, well as the fact of being labeled with a high risk for the risk scales. Complexity and duration of the surgery showed a statistically significant association with intensive care unit admission, as well as the fact of present intra-operative complications. Emergency surgery was not significantly associated with intensive care unit admission of surgical patients, although these patients had significantly higher numbers of intra- and post-operative complications, and more exitus than those undergoing elective surgery. CONCLUSIONS A greater incidence of intensive care unit admission of patients undergoing emergency surgery should significantly reduce morbimortality rate. The existence of specific protocols for intensive care unit admission for urgent surgery, and greater availability of beds could be useful in this regard.
Collapse
Affiliation(s)
- J Gil Bona
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - A Pascual Bellosta
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Ojeda Cabrera
- Departamento de Estadística, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, España
| | - S Ortega Lucea
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - L Muñoz Rodríguez
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Martínez Ubieto
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Pérez-Navarro
- Servicio de Anestesiología, Hospital Universitario Miguel Servet, Zaragoza, España
| |
Collapse
|
41
|
Bing-Hua YU. Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg 2014; 208:268-74. [PMID: 24480235 DOI: 10.1016/j.amjsurg.2013.08.044] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/25/2013] [Accepted: 08/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shortage of beds in intensive care units (ICUs) is an increasing common phenomenon worldwide. Consequently, many critically ill patients have to be cared for in other hospital areas without specialized staff, such as general wards, emergency department, post anesthesia care unit (PACU). However, boarding critically ill patients in general wards or emergency department has been associated with higher mortality. The purpose of this study was to evaluate if a delay in ICU admission, waiting in PACU and managed by anesthesiologists, affects their ICU outcomes for critically surgical patients. METHODS A retrospective cohort of adult critically surgical patients admitted to our ICU between January 2010 and June 2012 were analyzed. ICU admission was classified as either immediate or delayed (waiting in PACU). A general estimation equation was used to examine the relationship of PACU waiting hours before ICU admission with ICU outcomes by adjusting for age, patient sex, comorbidities, surgical categories, end time of operation, operation hours, and clinical conditions. RESULTS A total of 2,279 critically surgical patients were evaluated. Two thousand ninety-four (91.9%) patients were immediately admitted and 185 (8.1%) patients had delayed ICU admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P < .001). Prolonged waiting hours in PACU (≥ 6 hours) was associated with higher ICU mortality (adjusted odds ratio 5.32; 95% confidence interval 1.25 to 22.60, P = .024). However, longer PACU waiting times was not associated with mechanical ventilation days, ICU length of stay, and ICU cost. CONCLUSION Prolonged waiting hours in PACU because of ICU bed shortage was associated with higher ICU mortality for critically surgical patients.
Collapse
Affiliation(s)
- Y U Bing-Hua
- Department of Anesthesiology, Central Hospital of Yiwu City, Yiwu, Zhejiang Province, China.
| |
Collapse
|
42
|
Abstract
BACKGROUND Anxiety may not be recognized by physicians though they affect a large number of patients awaiting surgery as reported in some studies. Good doctor-patient communication may have an impact on preoperative anxiety. AIM To find out the incidence of anxiety in patients awaiting surgery and its association with good doctor-patient communication. MATERIALS AND METHODS The study was undertaken in a medical college hospital situated in an industrial township, for the duration of two months. It was a cross-sectional study. The study included 79 patients admitted to various surgical wards of a teaching hospital. Data was collected on a pretested questionnaire, which included a set of questions on various aspects of doctor-patient communication. The level of anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was carried out using the WHO/CDC package EPI INFO 2002. Though preoperative anxiety was collected on an ordinal scale, later during analysis, it was collapsed to give a categorical scale. Aspects of doctor-patient communication associated with preoperative anxiety were explored by Chi square tests. RESULTS Out of the total 79 patients, 26.5% reported definite anxiety levels. Good doctor-patient communication was found to be inversely associated with anxiety levels in the preoperative period. CONCLUSIONS Preoperative anxiety is a common phenomenon among indoor surgical patients. A lot can be done to alleviate this anxiety by improving doctor-patient communication.
Collapse
Affiliation(s)
- Vandana B Nikumb
- Department of Community Medicine, D Y Patil, Medical College, Pune - 411 018, India
| | | | | | | |
Collapse
|
43
|
Gnanaraj J, Jason LYX, Khiangte H. High quality surgical care at low cost: the diagnostic camp model of Burrows Memorial Christian Hospital (BMCH). Indian J Surg 2007; 69:243-7. [PMID: 23132995 DOI: 10.1007/s12262-007-0034-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 12/15/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The major problems that patients in rural areas face are related to accessibility, affordability and availability. AIMS OF THE STUDY This study aims to evaluate how effectively the Diagnostic Camp Model of the institution meets the surgical needs of rural patients, by examining the logistics, economics and extent of the service provided. SETTINGS AND DESIGN A retrospective study of patients attending the Diagnostic camps run by the staff of BMCH including the follow-up of these patients at the hospital. MATERIALS AND METHOD The diagnostic camps involve transporting medical personnel and modern diagnostic equipment into the interior villages of various North Eastern states of India. Patients requiring surgical intervention later attend the hospital for surgery with the assistance of a health insurance scheme. STATISTICAL ANALYSIS The local C3MDS computer software was used to obtain statistical reports from a diagnostic camp held at Saiha, Mizoram. Previous hospital data and the Government of India census were used to estimate the number of men requiring surgical intervention for Benign Prostatic Hyperplasia (BPH). RESULTS About three quarters of surgical patients, who attended the surgical camp were unaware of their diagnosis prior to the camp. There was an overall profit despite the expected losses at the Hospital. These camps are a feasible and profitable venture on their own. About 50% of patients estimated to require surgical intervention for BPH in three districts of Mizoram received the necessary interventions. CONCLUSION This model is an attractive, cost effective, efficient way of meeting the surgical needs of patients from a large geographical area.
Collapse
Affiliation(s)
- J Gnanaraj
- Alipur, Banskandi Post, Cachar District, Burrows Memorial Christian Hospital, Assam, 788 101 India
| | | | | |
Collapse
|