Recovery Of Patients Research Articles

BN SO34 - Outcomes in giant versus non-giant hiatus hernia repair: Same payment different operative burden

Abstract Background Hospital trust payment for operative procedures often rely on coding systems like the NHS's Office of Population Censuses and Surveys (OPCS) codes, which determine reimbursement rates. Both giant hiatus hernia (GHH) and non-giant hiatus hernia (NGHH) repairs often share the same code, as in our trust. This results in equal reimbursement to trusts for procedures with higher operative burden and resource needs. This study aims to assess differences in the patient population, their hiatal type, operative challenges and post-operative outcomes between GHH and NGHH repairs. Method All patients undergoing primary hiatus hernia surgery between March 2019 to March 2024 at a single institution were included. Retrospective review of electronic records were utilised to record: patient demographics, hernia type, operative details, length of stay (LOS), post-operative course and need for a return to theatre (RTT). Outcomes were comparison of surgical approach, use of mesh and gastropexy (as proxy measures to indicate difficulty of operation), 30-day morbidity measured using Clavien-Dindo (CD) grading and 30-day mortality and RTT. Analysis was undertaken using un-paired t-test and Chi2. A p-value of <0.05 was considered statistically significant. Results Table 1. Patients GHH NGHH p n 91 135 Age (average) 69 (±10) 52 (±16) <0.001 Female (%) 66.7 55.2 0.1100 BMI 30.8 (±5.4) 30.7 (±7.8) 0.2029 ASA grade (average) 2.2 1.9 <0.001 Hernia Types (median) 3 1 <0.001 Table 2. Operative details GHH NGHH p Open (%) 6.6 0 0.0020 Laparoscopic (%) 60.4 62.24 0.9840 Robotic (%) 33 33.3 0.9239 Mesh used (%) 8.8 0.7 <0.041 Gastropexy (%) 12 0.7 <0.001 Table 3. Outcomes GHH NGHH p LOS (median) 2 (0-161) 1 (0-8) 0.0179 RTT (%) 10.7 8 0.4747 30-day morbidity (CD≥3, %) 4.8 4.4 0.6519 30-day mortality 0 0 NA Conclusion This study highlights significant differences between giant hiatus hernia (GHH) and non-giant hiatus hernia (NGHH) repairs. GHH repairs have an increased likelihood of undergoing open procedures, use of mesh, and gastropexy, reflecting their greater complexity. GHH patients are older, have higher ASA grades, and present with more advanced hernia types compared to NGHH patients. Additionally, GHH repairs result in longer hospital stays. The findings underscore the need for improved coding accuracy to reflect these disparities accurately in patient demographics, operative strategies, and recovery outcomes within hospital trusts, ensuring appropriate resource allocation and reimbursement based on procedural complexity.

AHP SO08 - Weekend physiotherapy pilot for patients on hepatobiliary enhanced recovery pathways: Examining the impact of a 7-day service

Abstract Background Enhanced recovery after surgery (ERAS) is a safe, multi-disciplinary, evidenced-based approach to optimise the perioperative management and outcomes after hepatobiliary (HPB) surgery. Despite the adoption of the ERAS mobilisation protocols to improve recovery time, one limitation is a traditional 5-day service model (Monday-Friday). This can result in an inequality of service provision for those patients operated Thursday or Friday and lead to increased length of stay (LOS) in hospital. Mobilisation across 7 days can ensure improved compliance with ERAS mobilisation protocols, better continuity of care, facilitate improved outcomes and timely discharge from hospital. Method Data was collected pre-introduction of the 7-day physiotherapy service from May-October 2022. During November 2022 – April 2023 a 7-day physiotherapy service was piloted. This service included 1 qualified physiotherapist and 1 non-qualified physiotherapist on Saturday and Sunday. This 7-day service provided continuity of care for patients from intensive care or post-anaesthesia care unit to the ward, facilitating discharges and accelerating return to independence. Data was collected during the 7-day service as well as 6 months post intervention (May 2023-October 2023). Acceptability of the intervention was assessed among the HPB multi-disciplinary team (MDT) using a survey consisting of 5 qualitative questions. Results The table illustrates that a reduction in mean LOS was seen in all 4 HPB surgeries that follow ERAS protocols during the 7-day physiotherapy service. It was also shown that 6-months post intervention (returning to a 5-day service) all 4 HPB ERAS surgeries mean LOS increased. To determine the acceptability of the 7-day physiotherapy service, 22 members of the MDT responded to a survey (5 consultants, 4 physiotherapy staff, 4 sisters, 5 staff nurses, 1 nursing assistant, 2 healthcare assistants). All 22 members of the MDT agreed that a 7-day physiotherapy service was acceptable and improves recovery. Conclusion A 7-day physiotherapy service has shown to reduce mean LOS in comparison to a 5-day physiotherapy service within HPB ERAS pathways. From an MDT perspective the 7-day physiotherapy service was also deemed to be beneficial and improves patient recovery.

HPB SO10 - Evaluation of the impact of an Enhanced Recovery Pathway on clinical outcomes after Pancreaticoduodenectomy

Abstract Background Southampton General Hospital (SGH) is a high-volume HPB centre with a well-established Enhanced Recovery After Surgery pathway (ERAS). Despite the morbidity associated with pancreatic surgery, there is a large body of evidence supporting the use of a multi-modal approach to accelerate patient recovery. Within SGH, ERAS is utilised for all patients undergoing Pancreaticoduodenectomy (PD). Initial assessment of the pathway in SGH demonstrated a reduction in length of stay. Since its implementation, ERAS has been modified to optimise the pathway. The aim of this study was to assess whether the impact of ERAS had progressed over time. Method Single centre retrospective analysis of patients undergoing open PD from 2007-2023. Pancreatic reconstruction was with pancreaticojejunostomy. Pre and Post ERAS data were analysed. Post ERAS data was subdivided into Early, Middle and Late implementation time phases. Length of Stay, Complications (Clavien-Dindo Grade 3 and above), Readmissions and Mortality were all examined. Non-parametric data analysis was undertaken with Kruskal-Wallis, Spearman rank correlation and Wilcoxon rank-sum tests. Significance further assessed with Multi-variate regression (MVR). All Data were analysed using STATA. Results Overall, 861 patients underwent an open PD, the yearly volume increasing with time. Mean age was 66 years, which did not change with time. With ERAS implementation, Median Length of Stay (LOS) fell 13 to 9 days (p<0.01) and there was no statistically significant increase in Grade 3 complications or Readmissions (p=0.931, p=0.163). Grade 3 complications increased LOS (p<0.01). Increased age led to a small increase in LOS (p<0.01). Median LOS across Early, Middle and Late ERAS periods was 10, 9 and 9 respectively. LOS did not consistently demonstrate a statistically significant improvement across ERAS phases (MVR p=0.387, K-Wallis p<0.05). Conclusion The implementation of ERAS significantly reduced the median LOS for patients undergoing PD, without increasing their risk of complications or readmissions. This benefit has also been safely maintained across the period of its implementation.

Abstract 4136694: Impact of left ventricular support devices on myocardial and pulmonary recovery in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation

Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is used to treat cardiogenic shock. However, retrograde arterial perfusion from the femoral artery can increase left ventricular (LV) afterload, resulting in LV distention which may hamper myocardial recovery and worsen pulmonary congestion. An intra-aortic balloon pump (IABP) can mitigate LV afterload, and Impella (Abiomed, Danvers, MA) can directly unload LV pressure. This study aimed to evaluate the efficacy of LV support devices during VA-ECMO in patients with cardiogenic shock. Methods: We retrospectively collected data from 213 consecutive patients treated with VA-ECMO due to cariogenic shock at our institution between January 2013 and December 2023. Patients were categorized as either receiving VA-ECMO alone or VA-ECMO with an LV support device. The LV support device was characterized as VA-ECMO with IABP or Impella. Data were analyzed for mortality, weaning from VA-ECMO, and changes in pulmonary congestion using the congestion score index (CSI), which is a semi-quantitative approach to pulmonary congestion based on a 6-zone evaluation of chest radiography, scoring each zone from 0 (no congestion) to 3 (intense pulmonary edema). Results: In this study, 95 patients received VA-ECMO alone, whereas 118 patients received an LV support device (101 VA-ECMO with IABP and 17 VA-ECMO with Impella). LV support devices improved weaning from VA-ECMO (odds ratio, 3.09 [95% confidence interval (CI), 1.75–5.55]; p<0.0001) whereas there was no difference in IABP versus Impella cohorts. Compared with VA-ECMO alone, patients with VA-ECMO with an LV support device had better survival at 30 days (OR, 3.04 [95% CI, 1.73–5.43]; p<0.0001). The rate of survival to discharge was better in VA-ECMO with an LV support device versus VA-ECMO alone (hazard ratio, 2.51 [95% CI, 1.72–3.65]; p<0.0001). The evaluation of pulmonary congestion using the CSI revealed that congestion significantly improved in VA-ECMO with Impella (changes of CSI: 1.86 to 1.36) but not in VA-ECMO with IABP (1.80 to 1.96) and VA-ECMO alone (1.94 to 2.14). Conclusion: An LV support device may be associated with reduced mortality and increased success in weaning off VA-ECMO in patients with cardiogenic shock. Impella may be particularly effective in reducing pulmonary congestion.

Clinical efficacy of optical coherence tomography parameters to predict the visual field outcome following pituitary adenoma surgery.

To investigate the factors affecting visual field recovery in patients with pituitary adenoma following surgical removal, both eyes of 35 patients with pituitary adenoma who had been followed up for > six months post-surgery were retrospectively analyzed. Pre- and post-operative visual acuity, visual field test, retinal nerve fiber layer (RNFL), and ganglion cell inner plexiform layer (GCIPL) thickness were investigated. The average age of the 35 patients was 58.3 ± 11.5 years. Preoperatively, 30 eyes (mean average RNFL thickness, 99.73 ± 5.89 μm) and 40 eyes (mean average RNFL thickness, 77.55 ± 8.35 μm) were included in the thick (≥ 90 μm) and thin RNFL group (< 90 μm), respectively. In the thick RNFL group, pre- and post-operative mean deviation (MD) and pattern standard deviation (PSD) were favorable (all p < 0.001), and the proportion of eyes of postoperative MD change which were stable or improved was greater than in the thin RNFL group (p = 0.042). Preoperative MD, RNFL (except nasal quadrant) and GCIPL thickness were positively correlated to postoperative MD values (all, p < 0.05). Preoperative MD and temporal RNFL thickness were significantly correlated with postoperative MD change rate (p = 0.03 and 0.04, respectively). Preoperative GC IPL thickness and postoperative MD change rate were not significantly correlated (p = 0.61). Using univariate regression analysis, preoperative best corrected visual acuity (Odds ratio [OR], 0.050; p < 0.001), tumor volume (OR, 1.110, p = 0.002), higher preoperative MD values (OR, 0.858; p < 0.001), lower preoperative PSD values (OR, 1.169, p = 0.002), thick RNFL (OR, 0.215; p = 0.003) and thick GCIPL (OR, 0.305, p = 0.018) were significantly associated with a good visual field outcome following surgery. According to multivariate analysis, any other parameters were not significant. In patients with thick RNFL, postoperative MD values were better than in the thin RNFL group. Eyes with preoperative higher MD and thick temporal RNFL showed more improvement in their visual fields postoperative. Preoperative thick RNFL could be a potential predictor of visual field recovery following TSA-TR, while macular GCIPL thickness does not appear to be a reliable predictor.

Mesenchymal Stem Cell Therapy to Reduce the Neurological Deficit of Chronic Ischemic Stroke Patients: A Systematic Review

Current ischemic and hemorrhagic stroke treatments are limited by a narrow golden period and lack of regenerative benefits, so stem cell therapy emerges as an ideal candidate for functional recovery in stroke patients. Stem cell therapy, still being studied, is expected to repair ischemic areas damaged by stroke to restore their physiological functions and reduce neurological deficits in chronic stroke patients. This study aimed to determine the therapeutic efficacy of MSCs in reducing neurological deficits in chronic ischemic stroke patients. We conducted a systematic review. We searched PubMed, Cochrane Library, Science Direct, and Springer Link from inception until December 2022 for cohort studies dealing with mesenchymal stem cell therapy for patients with ischemic stroke. The citation-searching method in this study collected 1,038 articles using the advanced searching method and 8 articles using the citation-searching method, bringing the total number of articles to 1,046. The exclusion criteria used were articles with systematic reviews and meta-analyses and articles that were not accessible in full text. Based on the results of a systematic review study conducted, the conclusion that can be drawn is that MSCs therapy has proven effective in reducing neurological deficits in chronic ischemic stroke patients in terms of the decreased NIHSS score.

Biliary tract infections caused by Enterococcus gallinarum and Escherichia coli: a rare case report.

Enterococcus gallinarum (E. gallinarum), an opportunistic pathogen with intrinsic resistance to vancomycin, has rarely been reported as a predominant pathogen responsible for biliary tract infections. Here, we report a case of biliary tract infections caused by E. gallinarum and Escherichia coli (E. coli) in a 57-year-old Chinese woman with symptoms of upper abdomen pain for 10days. The patient initially received empiric treatment with cefmetazole but failed to improve. Subsequently, bile cultures identified E. gallinarum and E. coli, and cefmetazole was switched to linezolid and meropenem based on drug susceptibility testing. After 10days of antibiotic therapy, the patient successfully recovered and was discharged from the hospital. The findings of this case remind us that E. gallinarum may be the causative factor of biliary tract infections, and timely identification of the causative organism and appropriate antibiotic treatment is important for optimal patient recovery.

A cross-sectional study on post-stroke depression and the quality of life.

Post-stroke depression (PSD) is a common mood disorder associated with stroke. By investigating the differences in life quality factors among stroke survivors, the results of this study offer insights into how to better prevent and manage the onset and progression of depression. This study is a cross-sectional study that selected patients receiving treatment in the Department of Rehabilitation Medicine at Hebei University Affiliated Hospital from September 1 to November 30, 2023. The inclusion criteria for this study were as follows: 1.Age ≥ 18 years; 2. Diagnosis of hemorrhagic or ischemic stroke confirmed by imaging examination. The exclusion criteria included: 1. A history of psychiatric disorders such as depression or anxiety prior to the onset of the illness; 2.History of psychiatric medication use before the onset; 3.Functional impairments, such as speech, cognitive, or consciousness disorders, that hinder cooperation with the survey questionnaire. Ultimately, a total of 131 patients were included in the study. Based on the results of the Patient Health Questionnaire-9 (PHQ-9), patients were divided into the PSD group and the non-PSD group. The primary evaluation metrics included the General Self-Efficacy Scale (GSES), Visual Analogue Scale (VAS), modified Rankin Scale (mRS), and Fatigue Assessment Scale (FAS), allowing for a comparison of demographic, clinical data, and evaluation metrics between the two groups. Statistical analysis was performed using SPSS version 25.0, and GraphPad Prism version 9.0 was used for graphical representations. The morbidity rate of PSD in this study was 48%, which was slightly higher than the global statistical data. The demographic data did not show any statistical differences in terms of age, sex, history of smoking and drinking, or occupation, but they did show a significant difference in terms of education level (p < 0.05), which was primarily related to low education level in the PSD group. In contrast, the clinical data did not show any differences in terms of stroke type, pathogenic site, or medical history (p > 0.05). In this study, statistical results indicated no significant difference in the mRS between the two groups. However, the GSES, VAS, and FAS showed significant differences. This suggests a strong correlation between GSES, VAS, and FAS with the occurrence of PSD, indicating that these factors may serve as predictors for PSD. In medical practice, focusing on patients' self-efficacy, pain, and fatigue levels could facilitate recovery. When developing rehabilitation plans, it is crucial to minimize patients' feelings of self-defeat, enhance their self-efficacy, and manage fatigue effectively. Furthermore, reinforcing pain management throughout the rehabilitation process may promote more effective patient recovery.

Exploring Haptoglobin as a Promising Marker for Severe Liver Diseases: A Comprehensive Review

Liver damage is a common symptom of many diseases, including metabolic disorders and cancers. Such patient condition requires effective examinations aimed at prompt diagnosis and implementation of the most appropriate treatment for a specific disease. Haptoglobin, the subject of many studies, has proven to be a protein that can be used as a biomarker of liver damage, thereby aiding not only in the diagnosis but also in the treatment, resulting in more favorable prognoses regarding patient longevity and quality of life.The aim of this study is to elucidate the role of haptoglobin as a diagnostic and prognostic biomarker in cases of liver damage.This is a review of scientific literature and analysis of clinical data regarding haptoglobin levels in liver damage were conducted to assess the reliability of haptoglobin as a biomarker.This paper primarily utilized the latest publications produced after 2015. PubMed and Google Scholar were used to find relevant publications. All cited works provided useful information to achieve the aim of our article.Analysis of the literature suggests that haptoglobin levels may be significantly associated with the development and severity of liver damage. It may serve as a suitable biomarker for diagnosing diseases that coincide with hepatocyte damage, thus improving the diagnosis of these diseases and increasing the chance of appropriate treatment, which may contribute to prolonging and improving the patient's quality of life.Haptoglobin appears to be a promising biomarker in liver damage; however, further research is necessary to confirm its diagnostic and prognostic accuracy. Haptoglobin exists in various genotypic forms, each characteristic of different disease entities. Understanding the mechanisms regulating haptoglobin levels may lead to a better understanding of liver damage pathogenesis and the development of more effective therapies, increasing the chance of patient recovery and improving their quality of life.

Comparative clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis vs. chemical pleurodesis in the management of spontaneous pneumothorax

ObjectiveThis study aims to observe the clinical efficacy of single-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis compared to traditional iodine chemical pleurodesis in the treatment of patients with spontaneous pneumothorax.MethodsA total of 128 patients with spontaneous pneumothorax who underwent surgical treatment at our institution from January 2021 to December 2022 were selected. Patients were categorized into the study group (n = 65) and the control group (n = 63) based on the surgical method used. The study group received C-shaped pleura cautery for pleurodesis, while the control group underwent traditional iodine chemical pleurodesis. Surgical and clinical outcomes were evaluated, and recurrence rates within one year postoperatively were compared. Serum C-reactive protein (CRP) levels and visual analog scale (VAS) scores were measured at different time points.ResultsNo significant differences were observed between the two groups regarding surgical duration, intraoperative blood loss, or postoperative hospital stay (p &amp;gt; 0.05). However, the study group demonstrated significantly lower serum CRP levels and VAS scores on postoperative days 1 and 2, as well as reduced drainage volumes compared to the control group (p &amp;lt; 0.05). The recurrence rates of pneumothorax within one year postoperatively did not differ significantly between the groups (p &amp;gt; 0.05).ConclusionSingle-incision thoracoscopic bullectomy combined with C-shaped electrocautery pleurodesis is an effective treatment for spontaneous pneumothorax. Compared to traditional iodine chemical pleurodesis, this method causes less pleural irritation, results in lower postoperative pain and drainage, and facilitates patient recovery, making it a safe and reliable option for the management of spontaneous pneumothorax.

A Prospective, Randomized, Controlled Trial of Methylene Blue Injection for Costal Cartilage Harvest Postoperative Analgesia.

In plastic surgery, costal cartilage is an excellent support material. However, postoperative pain from costal cartilage harvesting can impact patient recovery and satisfaction with the surgery. Recent reports have shown that methylene blue (MB) is an effective local analgesic in postoperative management. We aimed to evaluate the safety and effectiveness of MB for pain relief in patients undergoing costal cartilage harvesting. A total of 106 patients undergoing costal cartilage harvesting surgery were selected from the plastic surgery department between December 2022 and March 2024. They were randomly divided into 2 groups: the MB group and the ropivacaine group, with 53 patients in each group. Pain levels were assessed with a numerical rating scale, the Insomnia Severity Index (ISI), arm elevation angle, and postoperative satisfaction scales at 1 day, 3 days, 5 days, 1 week, 1 month, and 3 months postoperatively. Patients receiving MB exhibited a significant decrease in pain scores from 5 days to 1 month of treatment compared to the ropivacaine group. Additionally, in the MB group there was an improvement in ISI scores from 5 days to 1 month compared to the ropivacaine group. Furthermore, during the 3-month follow-up, the MB group had significant increases in satisfaction scores compared to the control group. Arm elevation angle in the MB group was significantly higher compared to the ropivacaine group at 5 days, 1week, and 1month. No serious adverse events were reported, with only 2 patients experiencing an allergic rash. Methylene blue demonstrated significant pain reduction with minimal adverse effects.

Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis.

Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear. This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery. A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes. A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference -15.00, 95% CI -25.65 to -4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45%) in the likelihood of PPCs (risk ratio 0.45, 95% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference -1.53, 95% CI -2.95 to -0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference -1.42, 95% CI -3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates. This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research. PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=430271.

Undergoing Orthopaedic Day Surgery: What Factors Are Associated With patients' Feeling of Safety and Their Recovery?

The study aimed to examine factors associated with the perceived feeling of safety and postoperative recovery in patients who have undergone orthopaedic day surgery under regional anaesthesia. The design was quantitative, descriptive, and cross-sectional. The study participants comprised a consecutive sample (n = 209) of patients who underwent orthopaedic day surgery under regional anaesthesia. A questionnaire was sent to the home addresses of the study population approximately 3 weeks postoperatively. The questionnaire included the Feeling Safe During Surgery Scale (FSS), the Swedish version of the post-discharge surgical recovery scale (S-PSR), and questions concerning background variables. Multivariate regression models were used to examine the association of different variables with both feeling safe and postoperative recovery. The only factor associated with the feeling of safety was preoperative anxiety; higher levels of preoperative anxiety were associated with lower levels of perceived safety during surgery. The factors associated with postoperative recovery were the recovery process itself and the patient's feeling of safety. Higher levels of postoperative anxiety were associated with a lower level of postoperative recovery. Higher levels of perceived safety during surgery were associated with higher postoperative recovery. The perceived feeling of safety in the perioperative period could not be explained by factors such as age, gender, or level of education. Based on the results of this study, postoperative recovery was associated with the perceived feeling of safety in the perioperative period. Anxiety in the perioperative period was associated with patients' perceived feeling of safety and their postoperative recovery. Thus, this study's results emphasise the importance of ensuring that people undergoing surgery feel safe to promote their recovery. Based on previous research, the nurse-patient relationship seems to be an important part of making patients feel safe, which ultimately affects their recovery. This study examines the association between perceived feeling of safety in the perioperative period and patients' postoperative recovery after undergoing orthopaedic day surgery under regional anaesthesia. Previous research has shown that the nurse-patient relationship and patients' possibilities to participate in their care are important for them to feel safe. This study further emphasises the importance of fostering relationships in the perioperative period and making patients an active part in decision-making, as it may positively impact their recovery. Creating a feeling of safety for the patient should be prioritised, as it benefits their perioperative experience and postoperative recovery. This research is reported in accordance with the STROBE guidelines. No patient or public contribution.

Cord Blood Platelet Lysate-Loaded Thermo-Sensitive Hydrogels for Potential Treatment of Chronic Skin Wounds

Background/Objectives: Chronic skin wounds (CSWs) are a worldwide healthcare problem with relevant impacts on both patients and healthcare systems. In this context, innovative treatments are needed to improve tissue repair and patient recovery and quality of life. Cord blood platelet lysate (CB-PL) holds great promise in CSW treatment thanks to its high growth factors and signal molecule content. In this work, thermo-sensitive hydrogels based on an amphiphilic poly(ether urethane) (PEU) were developed as CB-PL carriers for CSW treatment. Methods: A Poloxamer 407®-based PEU was solubilized in aqueous medium (10 and 15% w/v) and added with CB-PL at a final concentration of 20% v/v. Hydrogels were characterized for their gelation potential, rheological properties, and swelling/dissolution behavior in a watery environment. CB-PL release was also tested, and the bioactivity of released CB-PL was evaluated through cell viability, proliferation, and migration assays. Results: PEU aqueous solutions with concentrations in the range 10–15% w/v exhibited quick (within a few minutes) sol-to-gel transition at around 30–37 °C and rheological properties modulated by the PEU concentration. Moreover, CB-PL loading within the gels did not affect the overall gel properties. Stability in aqueous media was dependent on the PEU concentration, and payload release was completed between 7 and 14 days depending on the polymer content. The CB-PL-loaded hydrogels also showed biocompatibility and released CB-PL induced keratinocyte migration and proliferation, with scratch wound recovery similar to the positive control (i.e., CB-PL alone). Conclusions: The developed hydrogels represent promising tools for CSW treatment, with tunable gelation properties and residence time and the ability to encapsulate and deliver active biomolecules with sustained and controlled kinetics.

Enhanced Recovery After Surgery (ERAS) Protocols: Advancements and Implementation Challenges

Enhanced Recovery After Surgery (ERAS) protocols are a set of evidence-based guidelines designed to improve surgical outcomes by optimizing perioperative care. This approach integrates multidisciplinary strategies to reduce postoperative complications, shorten hospital stays, and enhance overall patient recovery. This article provides a comprehensive review of the advancements in ERAS protocols, including multimodal analgesia, optimized fluid management, early mobilization, and postoperative care. It also addresses the implementation challenges faced by healthcare systems, such as variability in adherence, resource constraints, and the need for interdisciplinary collaboration. By examining current evidence and real-world applications, this article highlights the potential benefits and obstacles of ERAS protocols, offering insights for future improvements and wider adoption.

Exploring the feasibility of Recovery Management Checkups for Primary Care in a Federally Qualified Health Center

IntroductionPrimary care settings present an opportunity for alcohol and substance use disorder (A/SUD) screening and treatment referral. However, there are recognized deficiencies in widely used treatment referral approaches, including acute care connections, vs. those that can support longer-term recovery. Recovery Management Checkups for Primary Care (RMC-PC) is an intervention with an evidence base for improving treatment referral and subsequent recovery for primary care patients; however, the intervention has never been fully implemented outside of a research context. We conducted a feasibility study to inform a future hybrid study of RMC-PC that will test the implementation and effectiveness of the intervention in primary care practice.MethodWe used a convergent mixed method design. The study’s setting was a Federally Qualified Health Center (FQHC) located in a large midwestern city. RMC-PC linkage services were administered by one of two treatment linkage managers: an FQHC linkage manager (F-LM) and a research staff linkage manager (R-LM). Quantitative data included (a) rates of positive A/SUD screening among a group of FQHC patients and (b) linkage manager service data (e.g., rate of successful meeting completion and days to completing of key events). Qualitative data included (c) an assessment of linkage manager’s motivational interviewing performance and (d) a focus group with FQHC staff focused on their perspectives on RMC-PC implementation determinants. Quantitative data were summarized using descriptive statistics, and linkage manager performance was compared. Qualitative data were analyzed using a hybrid deductive-inductive process.ResultsFifty percent of patients screened met moderate-high A/SUD risk. Eleven of 16 recruited patients completed at least one linkage manager meeting, with 63% completing both meetings. The F-LM delivered RMC-PC services alongside other duties successfully; however, three primary barriers to FQHC implementation were identified (difficulties applying motivational interviewing, incompatibilities of screening with FQHC technology and workflow, and lack of billing mechanism to support services).ConclusionRMC-PC is feasible for FQHC staff to deliver, though issues identified must be considered to ensure successful and sustainable implementation. Knowledge gained will inform a packaged implementation strategy that will be used in a future hybrid trial.

Prognostic impact of a 3-week multimodal prehabilitation program on frail elderly patients undergoing elective gastric cancer surgery: a randomized trial.

Research indicates that prehabilitation is effective in optimizing physical status before surgery, although this method may be considered "aggressive" for frail elderly patients. This study aimed to evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in frail elderly patients undergoing gastric cancer surgery, in comparison to usual clinical care. This study was a single-center, single-blind, randomized controlled trial. Patients over 65 years old with a Fried Frailty Index of 2 or higher, scheduled for gastric cancer surgery, were considered for inclusion. Eligible participants were randomized in a 1:1 ratio to either the intervention or control group. The intervention group underwent a 3-week multimodal prehabilitation program prior to surgery, in addition to perioperative care guided by ERAS protocols. The control group received only the latter. The primary outcome was the comprehensive complications index (CCI) measured at 30 days after surgery. Secondary outcomes included 30-day overall complications, functional walking capacity as assessed by 6-minute walking distance (6MWD) at 4 weeks postoperatively, and 3-month postoperative quality of life. This study was registered at ClinicalTrials.gov (No. NCT06510088). Among the 112 eligible patients, the median age was 74 years, with 58 (52.7%) being female.No between-group difference was found in the primary outcome measure, 30-day CCI. The Median (Q1-Q3) CCI for the intervention and control groups was 0 (0-12.2) and 0 (0-22.6) (P = 0.082), while the mean (SD) CCI was 6.1 (15.8) and 9.8 (12.7), respectively (P = 0.291). Notably, the incidence of severe complications (CCI > 20) was significantly lower in the intervention group compared to the control group (11.1% vs. 25.9%, P = 0.046), particularly in terms of medical complications (12.3% vs. 29.3%, P = 0.025). Preoperatively, 27 patients (47.4%) in the intervention group exhibited an increase in the 6MWD of at least 20m, compared to 16 patients (27.6%) in the control group (P = 0.028). At 4 weeks postoperatively, more patients in the intervention group returned to their baseline 6MWD levels (63.2% vs. 43.1%, P = 0.031). Secondary parameters of functional capacity in the postoperative period generally favored the multimodal prehabilitation approach. In frail elderly patients undergoing elective gastric cancer surgery, a prehabilitation program did not affect the 30-day postoperative complication rate or CCI but reduced severe complications and improved perioperative functional capacity. [ClinicalTrials.gov], [NCT06510088], [07/15/2024], [Retrospectively registered].

Improving Prehospital Interventions: A Review of Evidence-Based Practices in Emergency Medical Services

Emergency Medical Services (EMS) play a critical role in providing urgent care and stabilizing patients before they reach the hospital. The effectiveness of EMS interventions can significantly influence patient outcomes, making evidence-based practices essential in prehospital care. This review explores the latest evidence-based prehospital interventions in airway management, hemorrhage control, cardiac arrest response, pharmacological support, and trauma stabilization. By evaluating the current literature, this article highlights the impact of specific interventions on patient survival rates, recovery quality, and overall morbidity. Additionally, it examines challenges faced by EMS providers, including training limitations, resource disparities, and protocol adherence issues. Best practices such as standardized protocols, technology integration, and continuous training programs are discussed to address these challenges and improve EMS care. The findings underscore the importance of adopting and adhering to evidence-based practices in EMS to enhance patient outcomes and provide a foundation for future research on advanced prehospital interventions.

The Role of the International Classification of Functioning in Early Rehabilitation of Patients with Ischemic Stroke in Kyrgyzstan

The subject of the study is the process of early rehabilitation of patients after stroke. The aim of the study is to assess the role of the International Classification of Functioning (ICF) in the early rehabilitation of patients with ischemic stroke. This classifier was used to analyze the functional state of patients and develop individualized rehabilitation programs aimed at the most complete restoration of lost functions and improving the quality of life. As a result, it was found that the integration of the International Classification of Functioning into clinical practice contributes to a more effective and targeted recovery of patients after stroke. The classifier is a key point in determining short-term and long-term goals for the patient, assessing the rehabilitation potential and prognosis, drawing up and changing an individual medical rehabilitation plan, managing the medical rehabilitation process and forming further recommendations upon discharge, as well as involving related specialists to solve problems with barriers. It is recommended to implement the ICF at all stages of rehabilitation of patients after a stroke.

Comparing the performance of a femoral shaft fracture fixation using implants with biodegradable and non-biodegradable materials.

Orthopedic injuries, such as femur shaft fractures, often require surgical intervention to promote healing and functional recovery. Metal plate implants are widely used due to their mechanical strength and biocompatibility. Biodegradable metal plate implants, including those made from magnesium, zinc, and iron alloys, offer distinct advantages over non-biodegradable materials like stainless steel, titanium, and cobalt alloys. Biodegradable implants gradually replace native bone tissue, reducing the need for additional surgeries and improving patient recovery. However, non-biodegradable implants remain popular due to their stability, corrosion resistance, and biocompatibility. This study focuses on designing an implant plate for treating transverse femoral shaft fractures during the walking cycle. &#xD;The primary objective is to conduct a comprehensive finite element analysis (FEA) of a fractured femur's stabilization using various biodegradable and nonbiodegradable materials. The study assesses the efficacy of different implant materials, discusses implant design, and identifies the optimal materials for femoral stabilization. Results indicate that magnesium alloy is superior among biodegradable materials, while titanium alloy is preferred among non-biodegradable options. The findings suggest that magnesium alloy is the recommended material for bone implants due to its advantages over non-degradable alternatives.&#xD.