Candidate Patients For Surgery Research Articles

Assessment of Awareness, Attitude and Performance of Surgical Team about Medicinal Plants Use by Candidate Patients for Surgery

Due to the increasing application of traditional and complementary medicine methods as well as medicinal herbs and given the drug interactions during surgery, the goal of this study was to determine the awareness, attitude and performance of surgical team regarding the use of herbs by surgical candidates. In this cross-sectional descriptive study, members of surgery and anesthesia team completed a data collection form, which included personal information and specialized questions (10 awareness, 9 attitudes, and 9 performance questions). The score for each awareness question was 0-2, which was 1-5 for attitude and performance questions, respectively. Quantitative data were reported with mean ±SD, and qualitative data were reported as frequency percentage. Quantitative variables were analyzed by Mann-Whitney and Kruskal-Wallis tests, and qualitative variables were assessed using Chi-square test. Among 185 participants, there were 99 women (53.6%). 31.4% of participants were specialists or assistants, 87.6% of them had moderate attitude, 82.3% showed poor performance and 82.2% poor awareness. The level of awareness was not significant in terms of specialization but that of attitude (p < 0.001) and performance (p < 0.019) was significant. Considering the growing trend of medicinal plants’ consumption in people, and given the moderate attitude, as well as poor awareness and performance of surgical team members toward medicinal plants, increasing knowledge level, prevention of drug interactions and potential side effects of medicinal plants together with training planning are essential for surgical team members to increase patient safety.

The topical application of tranexamic acid to control bleeding in inguinal hernia surgery candidate patients: A randomized controlled trial

Background and objectivesInguinal hernia surgery is a common procedure, especially for the elderly, who usually use anticoagulants and antiplatelet drugs. In this study, we evaluated the effectiveness of tranexamic acid (TXA) on the complications of inguinal hernia repair in patients using antiplatelets. Patients and methodsThis study is a randomized controlled trial that was performed during the 2018–2019 years. Forty patients with inguinal hernia and antiplatelet use were enrolled randomly into the two groups. In the intervention group, the patients received two injectable form (500mg/5 mL) of TXA, totally 10 mL as a topical application at the surgical site, and then the patient's surgical site was seen every 8 h for 48 h, and the patient was examined daily for one week. ResultsThe mean length of hospitalization, seroma, hematoma and infection in the two groups were not statistically significant (P > 0.05). However, the duration of surgery in the TXA group was significantly shorter than in the control group (54.85 vs. 68.72 min) (P < 0.001). The mean bleeding during surgery was significantly lower in the TXA group than in the control group (P < 0.001). ConclusionThe findings of present study indicate that topical TXA has a high ability to control bleeding. As a result, TXA is beneficial in terms of reducing bleeding and increasing the surgeon's satisfaction. Therefore, it is recommended that TXA be prescribed for patients requiring inguinal hernia surgery with a high risk of bleeding.

Consideration of laparoscopic metabolic and bariatric surgery during COVID-19 pandemic

: COVID-19 pandemic has severely challenged the healthcare resources and impacted the medical practice globally. In most of the nations involved, non-urgent, non-cancer procedures have been suspended to reallocate medical and paramedical staff to combating the pandemic and emergency cases. Laparoscopic metabolic and bariatric surgery (LMBS) was traditionally classified as elective procedures, therefore, a great number of hospitals have postponed or even cancelled such procedures during the outbreak of COVID-19. In addition, many of the bariatric surgery candidate patients are also worried about acquired infection if staying in the hospital. However, since the pandemic is predicted to be last for a relatively longer time as we expected, we have no reason not to resume elective procedures if resources are allowed. This paper focuses particularly on the impacts of COVID-19 pandemic on LMBS and when and how to resume it orderly. A special caution protocol should be developed and implemented when caring patients in order to minimize or even prevent the virus transmitting and spreading inside healthcare facility. The protocol includes triage and prioritization of patients, screening, protections in the inpatient ward, in the operating theater, and after surgery. The goal of enforcing these protocols is to help restarting our practice during the “new normal” era. The core principles of this protocol can also be applied to any surgical specialties.

Health care team understanding of patients’ desire for information on surgery and anesthesia: A cross-sectional study

BackgroundSpecial features of operating rooms and improper access to information about this area can cause fear and anxiety among patients before surgery. The present study aimed to determine the care team and patient's opinions about the related issues to surgical and anesthesia information. MethodsIn this cross-sectional study, 300 surgery candidate patients and 60 health care teams participated. Both groups were given the same questionnaire and were asked to comment on what essential and useful information do patients want to know before surgery? The questionnaire consisted of four parts: 1) five questions regarding demographic information, 2) eleven regarding patients’ desire for surgery information, 3) nine regarding anesthesia, and 4) Amsterdam Preoperative Anxiety scale for assess patients’ anxiety. Finally, patients’ willingness about how to receive requested information and the patients’ satisfaction were evaluated. The data were analyzed using SPSS V.22. ResultsPatient's desire to receive information about the surgical and the anesthesia field had a mean of 88.22% and 85%, respectively. Correlation of patients’ desire to receive information was similar to the care team's understanding (r = 0.88, p < 0.9). However, 201 of patients (67%) were dissatisfied with the information transference by the care team. The majority of patients (61%) tended to seek information about their surgeons, preferring the oral method (51%) over other information transferring methods. ConclusionThe care team's understanding of the patient information needs was high. However, many patients were not satisfied with the information provided by the care team. The culture of providing care is not prioritizing information for patients; thus, it is suggested to pay more attention to this domain of care.

Development of a novel geometrically-parametric patient-specific finite element model to investigate the effects of the lumbar lordosis angle on fusion surgery

The success of lumbar interbody fusion, the key surgical procedure for treating different pathologies of the lumbar spine, is highly dependent on determining the patient-specific lumbar lordosis (LL) and restoring sagittal balance. This study aimed to (1) develop a personalized finite element (FE) model that automatically updates spinal geometry for different patients; and (2) apply this technique to study the influence of LL on post-fusion spinal biomechanics. Using an X-Ray image-based algorithm, the geometry of the lumbar spine (L1-S1) was updated using independent parameters. Ten subject-specific nonlinear osteoligamentous FE models were developed based on pre-operative images of fusion surgery candidate patients. Post-operative FE models of the same patients were consequently created. Comparison of the obtained results from FE models with pre- and post-operation functional images demonstrated the potential value of this technique in clinical applications. A parametric study of the effect of LL was conducted for cases with zero LL angle, positive LL angles (+6° and +12°) and negative LL angles (−3° and −6°) on fused level (L4-L5), resulting in a total of 50 fusion simulation models. The average range of motion, intradiscal pressure, and fiber strain at adjacent levels were significantly higher with decreased LL during different directions except axial rotation. This study demonstrates that the LL alters both the intersegmental motion and load-sharing in fusion, which may influence the initiation and rate of adjacent level degeneration. This personalized FE platform provides a practical, clinically applicable approach for the analyses of the biomechanical changes associated with lumbar spine fusion.

Assessment of probiotic effects on colorectal surgery complications: A double blinded, randomized clinical trial

Background: Probiotics are living bacteria, which can be used as a food supplement to produce inhibitory agents and compete with pathogens in the guts. Nowadays, because of the easy accessibility and misuse of antibiotics, probiotic usage is increasing. The goal of our study is to assess the effects of probiotics on colorectal surgery complications.&#x0D; Methods: The enrolled cases were selected from colorectal surgery candidate patients, who referred to Sina and Imam Reza Hospitals of Tabriz University from April of 2016 to April of 2017. They were divided into two groups of study and control. For the study group, 7 days before surgery, one capsule of probiotics (Familact) was administrated every night, while the control group was given capsules of placebo.&#x0D; Results: Although the infective complications, mortality ratio and duration of hospitalization in the study group were lower than the control group, these differences were not statistically significant. Discussion: Our study confirmed that preoperative probiotic consumption in colorectal surgery had not affected complications or mortality of surgery and this finding is in disagreement with some previous studies. Perhaps, other strains of bacteria or different dosage, duration and rout of administration can have positive effects on these complications.&#x0D; Conclusion: This study showed that there was no correlation between probiotic consumption preoperatively and decreased complications or mortality after colorectal surgery.&#x0D;

Perioperative and Postoperative Effects of Preoperative Low-Calorie Restrictive Diets on Patients Undergoing Laparoscopic Sleeve Gastrectomy

ObjectiveA restrictive diet applied before bariatric surgery can be required to reduce the liver volume or as a necessity imposed by insurance companies. However, the benefits of preoperative weight loss remain controversial. The present study aimed to investigate the perioperative and postoperative outcomes of a restrictive diet applied before laparoscopic sleeve gastrectomy. Materials and MethodsThe data of 128 patients who received surgery in 2015 and 2016 were retrospectively analyzed. All patients were advised to follow a 4-week low-calorie (1000 cal) restrictive diet. Nevertheless, approximately 50% of patients did not accept the diet plan. We divided the patients into two groups as dieters (group 1) and non-dieters (group 2). ResultsIn group 1, changes in after-diet BMI and liver size were statistically significant (p < 0.001). In group 2, mean operation duration, mean hospitalization duration values, mean BMI values, and mean body weight at postoperative 1, 3, 6, and 12 months were statistically significantly higher than in group 1. No statistically significant difference was found between early complication rates of the groups (p = 0.844). ConclusionLow-calorie restrictive diet applied before laparoscopic sleeve gastrectomy has reduced liver volume and shortens surgery and hospitalization time but does not have any significance concerning early complications and weight loss after operation in 1 year. Also, non-adherence of the bariatric surgery candidate patients to the diet seems to be a challenge.

Psychological Evaluation of the Patient Treated for Skeletal Disharmony of the Jaws Corrected with Orthognathic Surgery: An Assessment Tool

The number of patients treated with orthognathic surgery is steadily increasing. It is estimated 1.2 million people in the US could benefit from orthognathic surgery. From a surgical standpoint the goal is to correct a functional handicap, whether it is an inability to correctly masticate, a presence of temporomandibular disease or airway abolition. Orthognathic surgery candidate patients normally are well aware of their dentofacial disharmony before seeking treatment. It is well documented that there is a high prevalence of psychological disturbances in patients seeking esthetic alteration through plastic surgery. Currently, the Oral Surgeon is limited in the management of the psychological aspect of patients undergoing orthognathic surgery since there is a lack of a validated tool for assessment. Our overall goal was to develop a survey focusing specifically on the patient’s perception regarding orthognathic surgery.

Biomarkers of epileptogenic zone defined by quantified stereo‐EEG analysis

In one third of patients with a diagnosis of pharmacoresistant focal epilepsy who are candidates for therapeutic surgery, cerebral areas responsible for seizure generation can be defined exclusively with invasive intracranial recordings. A correct presurgical identification of the epileptogenic zone (EZ) with intracranial electrodes has a direct impact on postsurgical outcome. We aimed at identifying biomarkers of the EZ based on computer-assisted inspection of intracranial electroencephalography (EEG). Computer-driven intracranial EEG analysis in the domains of time, frequency, and space was retrospectively applied to a population of 10 patients with focal epilepsy to detect EZ electrophysiologic markers. Next, a prospective study was performed on 14 surgery candidate patients. The stereo-EEG computer-assisted analysis of EZ boundaries performed blind from patients data was compared to that defined with the traditional visual inspection completed by neurophysiologists. In the retrospective study, the EZ was characterized by the combined detection of three biomarkers observed at seizure onset: (1) fast activity at 80-120Hz associated with (2) very slow transient polarizing shift and (3) voltage depression (flattening). Correlations between these indexes were calculated for each seizure. In the prospective study, the quantified analysis based on the three biomarkers confirmed a complete overlap between leads within the EZ identified by expert clinicians. In 2 of 14 patients the proposed biomarkers partially identified the EZ. Our findings demonstrate and validate with a prospective unbiased study the use of three neurophysiologic intracranial EEG parameters as excellent biomarkers of ictogenesis and as reliable indicators of EZ boundaries.

Recommendations of a group of experts for the pathological assessment of tumour regression of liver metastases of colorectal cancer and damage of non-tumour liver tissue after neoadjuvant therapy

Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.

Neoadjuvant chemotherapy: a new criterion for selection of candidate patients for surgery of low tumour burden metastases from malignant melanoma?

Surgery of limited metastatic lesions from malignant melanoma can achieve long-term remission and better survival than chemotherapy. Existing criteria for selection of candidate patients for this surgery do not seem sufficient to avoid useless excisions. To test use of neoadjuvant chemotherapy as a new criterion in this setting. All patients who underwent thoracic surgery for one or two lung metastases from melanoma during 1999-2007 were included in the study. Demographic and medical data were collected and analysed. Several possible prognostic factors were evaluated based on the overall survival curves. Thirteen patients were included in this retrospective study. All but two patients had no evidence of disease after surgery. Ten patients received neoadjuvant chemotherapy. Six responded (absence of progression) and four had progressive disease. Response to chemotherapy and no evidence of disease after surgery were predictive of long-term survival. Neoadjuvant chemotherapy can be considered as a new criterion for better selection of candidate patients for lung metastasis surgical resection. This would also avoid useless surgical procedures in rapidly progressive disease and give information on the chemosensibility of the metastatic disease. This study needs further confirmation, particularly with chemotherapy regimens that have demonstrated better objective responses.