Excellence For Patients Research Articles

Spontaneous elimination of gossypiboma: A case report

Introduction: The term gossypiboma refers to surgical items of textile matrix inadvertently left inside cavities after closure of the surgical wound. The unrecognized presence of a foreign body of any kind in the abdominal cavity after an operation is a situation rarely reported in the medical literature and surrounded by a potential for serious complications, which can evolve into a fatality. This article is an observational and descriptive case report. The information was collected by reviewing the medical records and photographic records of the surgical procedures the patient underwent. It aims to present a case of spontaneous elimination of gossypoma in a patient who had undergone a previous caesarean section. Report: Patient R.T.T.S, 17 years old, female, previously healthy, with sporadic diffuse abdominal pain for 10 months after caesarean section, with progressive worsening. One week ago, she had a significant worsening of the pain associated with constipation, difficulty in evacuating and, one day ago, anal elimination of contents similar to vegetable loofah (SIC). Physical examination revealed a slight bulge in the hypogastric region and rectal elimination of a foreign body. Discussion: Imaging methods are important allies in identifying this type of problem. The surgical approach adopted will depend on the clinical and radiological presentation of the gossypiboma. In the case reported here, we opted for rectal removal of the foreign body while preserving the integrity of the abdominal cavity, as the patient had no symptoms of abscess or fistulae. She evolved in the post-operative period in good clinical condition. Cases like this are increasingly reinforcing the need to adopt and strictly comply with checklists prior to surgery and at the end of surgery. In order to provide safe surgeries with excellence for patients in any institution in the country.

Ensuring safety of Novel Oral Anticoagulants Predictable Dose Response Relationship

Atrial fibrillation (AF) is also the most common cause of cerebrovascular morbidity and mortality in cardioembolic stroke patients. In patients with AF, oral anticoagulation treatment has shown to minimise the risk of cardioembolic stroke by more than half. Anticoagulation with vitamin K antagonists is best used with strict adherence and monitoring. Patient dissatisfaction can be caused by a number of causes, all of which lower the patient's excellence of life. New immediate oral anticoagulants, for example, the immediate factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, and the dabigatran thrombin inhibitor, were intended to defeat the shortcomings of conventional anticoagulant drugs. However, models to boost the estimation of treatment and guarantee that treatment can be securely proceeded are missing for existing oral anticoagulants. This survey will briefly examine the new oral anticoagulants dabigatran, apixaban, edoxaban, and rivaroxaban, with an attention on their utilization in the anticipation of embolic events in AF. It will look at the benefits for patients of life, just as the protection and adequacy of the treatment.

Leading a Culture Change to Nursing and Patient Excellence

To improve patient and nurse satisfaction on the postpartum and gynecology nursing unit through an improved positive practice environment.

Very rare disorders - organisation of care

Care for patients and their families with rare disorders is gradually recognised as being essential both on an individual basis and on a population scale. Attention is usually paid to those with disorders with prevalence between one in 2,000 to one in 100,000. Not many official bodies realise that the majority of patients with rare disorders have in fact disorders that are much rarer, with a prevalence of one in 1,000,000 to one in 100,000,000. This has consequences in providing the best care as the creation of support groups for such rare disorders is much more problematic, and centralisation of care cannot be established on a national level but only on a European level. This has wide-spread consequences, for instance regarding language, insurance, transportation, and research. The use of the internet to establish contacts, create Wikis around such rare entities, and to allow for e-mail consultations with medical experts elsewhere in Europe is emphasised and demonstrated using the entity Marshall-Smith syndrome (30 patients known in Europe) as an example. The establishment of large centres of excellence for patients with very rare disorders has been suggested, either one in each country or one for around populations of 30,000,000 Europeans, to provide essential care and form a basis for further research.

Best practice guidelines.

Best practice guidelines and multidisciplinary pathways of care are becoming an established and essential feature of clinical practice. They can be seen in a wide variety of clinical settings ranging right across the primary, secondary and tertiary health and social care spectrums. The 1997 White Paper places strong emphasis on quality and consistency of care delivery and gives assurances of performance measurements, integrated care (Wilson, 1996) and clinical governance. It suggests making healthcare delivery against national standards a local responsibility and quality of care the driving force for decision making at every level of the service to ensure excellence for patients no matter where the care is provided. A number of controversial issues surround the use of guidelines. Some argue that they are a fetter on clinical discretion, clinical freedom and can lead to the practice of 'cookbook medicine'. Others maintain that they are an essential aid to providing safe and appropriate medical and nursing care.