Postoperative Instructions Research Articles

Commentary: Pediatric cataract management during the COVID-19 era.

Commentary: Pediatric cataract management during the COVID-19 era.

Influence of Post-operative Instructions on Wound Healing. A Randomized, Single-blinded Clinical Trial.

Postoperative instructions that are properly delivered can play a major role in treatment outcomes, especially excellent wound healing. This study aimed to examine the mode of delivering postoperative instructions in decreasing the side effects of poor wound healing following simple tooth extraction. This single-blinded, randomized clinical trial was conducted on 400 patients presented for simple extraction of unimpacted teeth. The patients were randomly assigned to two groups of verbal and verbal plus written instructed groups. Collected data were analysed using descriptive and inferential statistics at a significance level of 95%. More men (51.5%) were seen. The participants' mean age was 37.3 ± 14.3 years (range, 18-87 years). The results showed that the mode of delivering instructions had a marked relation with socket healing. The post-extraction healing score was significantly higher in the verbal and written instructed group compared with the verbal instructions alone (P = 0.00). The age (P = 0.04) and type of instruction (P = 0.00) were significantly associated with excellent wound healing. Only the type of instruction that independently predicted the excellent wound healing (OR = 0.12; P = 0.00). The mode of delivering post-operative instruction affected the post extraction socket healing. Patients who received written and verbal instructions reported excellent post extraction socket healing than those who had verbal instructions only. All medical practitioners are recommended to use both verbal and written post-operative instruction

Prophylactic scheme with parenteral and oral dexamethasone for the control of edema, pain, and trismus after surgery on the wisdom teeth

Purpose The aim of this study was to demonstrate the effectiveness of prophylactic dexamethasone and compare the different routes of administration for the control of pain, edema, and trismus after surgery on the wisdom teeth, taking into consideration the general preference for the oral route over the intramuscular route. Therefore, it is hoped that the results of this work will allow us to determine the most effective dose and route and contribute to the generation of guidelines to improve the postoperative management of our patients. Methods The study included a total of 52 patients, of which 38 were females and 14 were males (age range 18–25 years; X = 21.60; Σ = 2.24); 26 received dexamethasone intramuscularly and 26 orally. Five patients were excluded for not complying with postoperative instructions. Results At the postoperative control, there were no differences between the parenteral and oral pathways in the control of facial edema and trismus for the periods evaluated. Patients in both groups presented with postoperative pain; and no differences were found for all of the periods evaluated, with the exception of 48 hours, in which case, 8 mg dexamethasone was used. The parenteral route was more effective (P = .000). At the postoperative control, as shown in Table IV, administration of dexamethasone via the parenteral route showed changes in edema and trismus compared with the preoperative evaluation (edema P = .000 and trismus P = .000); with regard to pain, no changes were reported at 24 hours (P = 1.000) or at 48 hours (P = .327). However, oral dexamethasone, as shown in Table V, changes in edema (P = .000), trismus (P = .000), and pain at 24 and 48 hours (P = .000) were noted; with regard to immediate postoperative pain, no changes were observed (P = .327). Table IV . Efficacy of parenteral dexamethasone prophylaxis to control edema, trismus and postoperative pain after surgery of wisdom teeth. Table V . Efficacy of oral dexamethasone prophylaxis to control edema, trismus and postoperative pain after surgery of wisdom teeth. Conclusions Intramuscular administration of dexamethasone showed no difference in effectiveness compared with the oral route with regard to edema, pain, and trismus after wisdom tooth surgery, except for the 48-hour period, during which intramuscular dexamethasone was more effective. Intermuscular dexamethasone route was effective to control pain at 24 and 48 hours after wisdom tooth surgery. Oral dexamethasone was effective in controlling pain immediately after wisdom tooth surgery.

Effect of Applying Postoperative Nursing Instructions 0nAnkle Open Reduction Internal Fixation Surgery Patients.

AbstractBackground: Fractures of the ankle are one of the most common lesions the orthopedic surgeon handles. Aim: to evaluate the effect of applying postoperative nursing instructions on ankle open reduction internal fixation (ORIF) surgery patients. Research design: Quasi experimental research design was utilized in this study. Setting: This study was performed in trauma units (male and female) and orthopedic clinic at Assiut University Hospital. Sample: This study included a convenient sample of (60 patients). Tool I: Interview questionnaire sheet Tool II: Patient complications assessment sheet. Results: In lateral wound ,it was found that one quarter of control group had normal healing while more than two fifth in study group . In medial wound healing it was found that more than one third of control group had normal healing while majority in study group. Conclusion: The present study revealed that providing patients with post-operative nursing instructions were represented of great value in wound healing and reduction other complications (residual pain, Malunion, infection, deformity). Recommendations: the present study should be replicated on larger study populations for generalization of the results.

Evaluation of Primary Stability in Immediate Loading of Dental Implants

Study Design: With the patient’s desire to shorten the treatment time and to avoid an edentulous condition, immediate loading of implants has emerged as an alternative approach as compared to delayed loading implants for replacing missing natural teeth. The aim of this study is to evaluate the primary stability in immediate loading of dental implants. Objective: To evaluate primary stability and postoperative complications clinically and radiographically. Method: Total 50 patients were treated with immediate loading dental implants. Withdrawal criteria includes patients not returning for checkup, follow-up, or documentation, and patients not following postoperative instruction. Result: Primary stability increases in immediate loading protocol; mean stability was 57 which was adequate at the time of surgery and during healing period. Conclusion: Our study concludes that under appropriate circumstances, medical condition and maintenance of good oral hygiene provide better primary stability in immediate loading protocol.

Alveolar ridge split technique and immediate implant placement in atrophic maxilla. Case series

Background: Alveolar ridge split technique (ARST) is a surgical procedure performed for horizontal ridge augmentation in cases of narrow crestal ridges. It is a biologically oriented technique, taking advantage of the osteogenic and osteoconductive dynamic of the native bone. Recently, the utilization of devices such as thin diamond disks or piezoelectric cutting devices has enhanced ARST success rate, reduced surgical time and patient's morbidity, regardless of bone quality. Aim/Hypothesis: The purpose of this poster is to present and discuss our experience in a series of clinical cases where ARST was performed for horizontal bone augmentation with simultaneous implant placement, using classical or piezoelectric-assisted surgical procedures. Materials and Methods: ARST was performed in 6 patients with 10 sites of horizontal defects. Under local anesthesia, a crestal incision was performed and a full thickness mucoperiosteal flap was reflected. Initial osteotomy was done using the classical technique in 6 cases (diamond disk, rotary burs), while a piezoelectric device was used to the remaining 4 cases. Osteotomes and chisels with gradually increasing dimensions were used to expand the alveolar ridge to facilitate the immediate placement of 18 implants, approximately 2 mm subcrestally in order to prevent marginal bone loss. The remaining space between bony plates was filled with allograft or xenograft and covered with collagen membrane in 9 cases, while in one case no bone graft or membrane were used. Primary closure without tension was achieved with periosteum releasing incisions of the buccal flap. Post-operative instructions included administration of antibiotic and analgesic, chlorhexidine solution, smoke cessation and thorough oral hygiene. Results: Sutures were removed 10 days postoperatively. Follow up was uneventful for 5 out of 6 patients. One patient did not comply with the postoperative instructions, applying poor oral hygiene and continuing smoking as before which resulted in exposure of the collagen-membrane the second week, leading to secondary wound closure compromising the augmentation. A new CBCT was performed 4 months following the split which revealed successful bone augmentation and implant osseointegration without any significant bone loss around the implants. Oral rehabilitation with either fixed or removable prosthetics was accomplished and the patients remain under systematic review. Conclusions and Clinical Implications: ARST is a predictable and reliable procedure characterized by its low invasiveness and morbidity. The major advantage is the simultaneous bone augmentation- implant placement, which provides reduced treatment time and cost. Piezoelectric devices make the split technique easier and safer, decreasing the risk of complications in the treatment of extremely atrophic crests. ARST's success and efficacy depends greatly on patient selection in order for the basic anatomical criteria to be fulfilled. Keywords: ridge splitting, horizontal bone augmentation, piezoelectric device

Pyogenic granuloma: Case series

Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Case report: 4 patients reported to the Department of Oral Surgery, Army College of Dental Sciences, Secunderabad complaining of a swelling of gums in front and back tooth region in upper and lower arch for past 6 months. The treatment plan included surgical excision of the lesion using diode laser as well as scalpel.Results: All the Four patients reported no pain after the surgery. They were discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. No recurrence or scarring was observed in 6-12 months follow-up. Conclusion: Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.

Postoperative Noncompliance following Repair of Acute Achilles Tendon Ruptures

Category:Trauma; Ankle; Hindfoot; SportsIntroduction/Purpose:Patient compliance with postoperative instructions is an important aspect of the orthopaedic surgery treatment regimen and can be a substantial deciding factor in achieving good outcomes. The postoperative period following acute Achilles tendon repairs requires diligent patient compliance in order to achieve optimal outcomes. The purpose of this study was to report the incidence of postoperative noncompliance and determine independent predictive factors of noncompliance following surgical management of acute Achilles tendon ruptures.Methods:A retrospective review of patients undergoing primary open repair of acute Achilles tendon ruptures with a single fellowship-trained orthopaedic foot & ankle surgeon at a single surgical location from 2010-2017 was performed. Patients <18 years of age, those who underwent surgical repair >21 days from the date of injury, those whose repair required a V-Y advancement, or those with bilateral tendon ruptures were excluded. Patient records were reviewed for collection of patient data and postoperative chart notes were reviewed to document instances of noncompliance. Instances were subcategorized into non- accidental or accidental. Multivariable regression analysis was performed to determine independent predictors of noncompliance. Regression coefficients with 95% confidence intervals [95% CI] and p-values were reported for significant findings. Mann-Whitney U tests were used to compare Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports scores and Visual Analog Scale (VAS) pain scores between compliant and noncompliant groups.Results:Of 232 patients meeting the inclusion criteria, 19 (8.2%) patients had 21 documented instances of noncompliance during the first 12 postoperative weeks, with 7/21 (33.3%) occurring during the first 2 postoperative weeks, 8 (38.1%) between weeks 3- 6, and 6 (28.6%) between weeks 7 and 12. Sixteen of the 21 (76.2%) instances of noncompliance were determined to be non- accidental, while 5 (23.8%) were accidental. Multivariable analysis demonstrated male sex (0.10 [0.00, 0.19]; p=0.0498) to be an independent predictor of non-accidental noncompliance. Age, BMI, a history of depression or diabetes, mechanism of injury, and timing of surgery following injury were not predictive of postoperative compliance. At mean 4.7 (range, 2.0-8.3) years postoperatively, the groups did not differ in FAAM-ADL (p=0.4311), FAAM-Sports (p=0.4258), or VAS pain (p=0.5050) scores.Conclusion:Postoperative noncompliance following surgical Achilles tendon repair occurs in nearly 1 out of every 12 patients, based on our cohort. Males, who make up the majority of Achilles tendon ruptures, have increased rates of non-accidental noncompliance. Patient noncompliance is an issue for orthopaedic surgeons of all subspecialties, and further investigations of incidence and risk factors should take place across a variety of commonly performed surgeries.

Development of User Created Content videos for Chinese smartphone users studying in Korea

Background/Objectives: The objective of the research was to develop User Created Content (UCC) videos to enhance basic nursing skills for Chinese smartphone users studying in Korea. Methods/Statistical analysis: Working together with Korean students and professors, Chinese international students produced two UCC videos for the inculcation of postoperative nursing skills and instruction in intravenous fluid injections. The videos contained both Korean and Chinese captions. Findings: The process of producing UCC videos by Chinese students was found effective: They participated in the selection of the topics and in the production of the videos. The effectiveness was determined through individual and group interviews. Greater instructional value was also due to the fact that Chinese international students acquired a greater sense of community in working with Korean students and professors in making the videos. Chinese students who participated in the production of the UCC videos could conveniently and effectively learn from their all-too-familiar smartphones. Improvements/Applications: Production of UCC videos by Chinese international students with Korean students and professors enhances learning basic nursing skills and helps to overcome linguistic and cultural differences. This outcome can present a way to enhance the quality of education and social well-being of international students in Korea.

Analysis of partial weight bearing after surgical treatment in patients with injuries of the lower extremity

IntroductionAfter surgical treatment of injuries of the lower extremity, partial weight bearing is often suggested until soft tissue consolidation. It is doubtful, if this recommendation can be implemented, even in the case that a patient is performing partial weight bearing with a physical therapist. Consequently the question remains, if patients are able to implement partial weight bearing after surgery and which factors favor incompliance.Materials and methods49 patients, who underwent surgical treatment after injuries of the lower extremity, were equipped with electronic shoe insoles on both sides. Different weight bearing instructions were given depending on the type of injury and surgery (full weight bearing vs. 20 kg weight bearing vs. non-weight bearing). Besides loading, other factors like age, gender, weight and physical activity were evaluated. Statistical analysis was performed using Chi-square and Fisher’s exact test with significance set at a p value < 0.05.Results25 of the 40 patients, who had to perform non- or partial weight bearing, were not able to follow postoperative instructions (compliance rate 37.5%). The average loading of the whole collective was 32.6 kg (4.8–109.2 kg). The specification of loading had no statistically significant influence on real loading (p-value 0.39). Elderly patients were less able to follow instructions than younger patients (36 vs 30.2 kg). Physically active compared to non-active patients overloaded their injured extremity (37.8 vs 28.7 kg). Patients with a high body mass index (BMI) encountered more difficulties to perform partial weight bearing than lightweight patients (36.9 vs 25.1 kg).ConclusionsMost patients were not able to follow loading limitation, even a few days after surgery and even if the patients were trained by a physiotherapist. Excessive weight bearing-related complications should be evaluated.

Prospective Evaluation of a Standardized Opioid Reduction Protocol after Anorectal Surgery

BackgroundSurgery for anorectal disease is thought to cause significant postoperative pain. Our previous work demonstrated that most opioids prescribed after anorectal surgery are not used. We aimed to evaluate a standardized protocol for pain control after anorectal surgery. MethodsWe prospectively evaluated a standardized opioid reduction protocol over a 13-mo period for all patients undergoing elective anorectal surgery at our institution. Protocol components include preoperative query, procedural local-anesthetic blocks, first-line nonopioid analgesic use ± opioid prescription of five pills, and standardized postoperative instructions. Patients completed questionnaires at postoperative follow-up. Patients with history of opioid abuse or use within 30 d of operation, loss to follow-up, or surgical complications were excluded. Primary outcome was quality of pain control on a five-point scale. Secondary outcomes included use of nonopioid analgesics, opioids used, and need for refill. ResultsA total of 55 patients were included. Mean age was 47 ± 17 y with 23 women (42%). Anorectal abscess/fistula procedures were the most common (69%) followed by pilonidal procedures (11%) and hemorrhoidectomy (7%). Most had general anesthesia (60%) with the remainder local anesthesia ± sedation. Fifty-four (98%) had procedural local-anesthetic blocks. Twenty-six patients (47%) were prescribed opioids with a median of five pills. Forty-seven patients (85%) reported the use of nonopioid analgesics. Forty-six patients (84%) reported excellent to very good pain control. About 220 opioid pills were prescribed, and 122 were reported to be used. One patient (2%) received an opioid refill. ConclusionsSatisfactory pain control after anorectal surgery can be achieved with multimodality therapy with little to no opioid use for most patients.

Assessing the Quality of Orthopaedic Operation Notes in Accordance With the Royal College of Surgeons Guidelines: An Audit Cycle.

IntroductionAccurate and detailed operation notes are of great importance in all surgical specialties not only for patient care but also for providing information for research, audit and medico-legal purposes. In this audit cycle, we assessed the quality of operation notes against the standards set by the Royal College of Surgeons of England.MethodologyA sample of 59 operation notes was randomly selected from the orthopaedics department at Ribat University Hospital and retrospectively audited by three reviewers according to the Royal College of Surgeons of England Good Surgical Practice guidelines released in 2014. A memory aid was then placed in the operation theatre, emphasising mainly the points with poor compliance in the audit. A re-audit was then performed for another 59 operation notes.ResultsDuring the first audit, 59 elective operation notes were reviewed, and there was good compliance with date documentation (86%), diagnosis (85%), operating surgeon (90%), assistants’ names (86%), operative procedure (98%), detailed post-operative instructions (98%) and the signature (75%). In the re-audit phase, another 59 operative notes were reviewed; four of them were emergency operations. An improvement was noted in documenting the information that had been poorly documented in the first audit. In the first audit, 20% of the operation notes were written by the operating surgeon, while only 14% were written by the operating surgeon in the re-audit.ConclusionOur implementation of a memory aid in the operation theatre helped to improve the reporting of some of the criteria; however, some components of the operation notes remained poorly filled in.

Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients

Background and purpose — Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA. We assessed the prevalence of hip dislocation following posterior approach total hip arthroplasty without postoperative hip precautions. Methods — A systematic review of multiple medical databases was performed using the PRISMA guidelines and checklist. All clinical outcome studies that reported dislocation rates and postoperative instructions following posterior approach, primary surgery, published within the last 6 years, were included. Results — 6,900 patients were included from 7 Level I–IV studies, with 3,517 treated with and 3,383 without precautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group). All but 1 study demonstrated no statistically significant differences in patient-reported outcome scores between restricted and unrestricted groups, including those pertaining to return to function, confidence, and pain. Interpretation — The review found no impact on dislocation rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores.

INFLUENCE OF POST-OPERATIVE INSTRUCTIONS ON WOUND HEALING. A RANDOMIZED, SINGLE-BLINDED CLINICAL TRIAL.

Postoperative instructions that are properly delivered can play a major role in treatment outcomes, especially excellent wound healing. This study aimed to examine the mode of delivering postoperative instructions in decreasing the side effects of poor wound healing following simple tooth extraction. This single-blinded, randomized clinical trial was conducted on 400 patients presented for simple extraction of unimpacted teeth. The patients were randomly assigned to two groups of verbal and verbal plus written instructed groups. Collected data were analysed using descriptive and inferential statistics at a significance level of 95%. More men (51.5%) were seen. The participants' mean age was 37.3 ± 14.3 years (range, 18-87 years). The results showed that the mode of delivering instructions had a marked relation with socket healing. The post-extraction healing score was significantly higher in the verbal and written instructed group compared with the verbal instructions alone (P = 0.00). The age (P = 0.04) and type of instruction (P = 0.00) were significantly associated with excellent wound healing. Only the type of instruction that independently predicted the excellent wound healing (OR = 0.12; P = 0.00). The mode of delivering post-operative instruction affected the post extraction socket healing. Patients who received written and verbal instructions reported excellent post extraction socket healing than those who had verbal instructions only. All medical practitioners are recommended to use both verbal and written post-operative instruction

Correcting Nipple Inversion Simultaneously with Implant Augmentation of the Breast, Using “Pirelli” Technique

Background:Most techniques of isolated nipple inversion correction are well published. Simultaneous breast augmentation with nipple inversion correction is less often found in the literature. Previously, nipple inversion correction was thought to be performed as a staged procedure after other breast operations. We present a study of 19 patients and 34 breasts who had concomitant breast augmentation and nipple inversion correction treated with a “Pirelli” technique to assess the complication rates and the rate of recurrence of inversion.Methods:The Pirelli technique was used, involving division of lactiferous ducts and deep closure of breast tissue before closure. An external “Pirelli tire” was then applied and secured circumferentially around the nipple–areolar complex, which helped to maintain eversion of the nipple after 1 week. Patients were then followed up with specific postoperative instructions to ensure wound healing and maintenance of eversion.Results:Nineteen patients were included where 34 breasts were involved. Eighteen patients had primary breast implants. The recurrence rate was 5.9%, involving 2 patients who had unilateral recurrences. These patients were managed with the same technique and had no further recurrences. Two patients successfully breastfed at a median time of 10 years postoperatively.Conclusion:Simultaneous breast mammoplasty with nipple inversion correction using the Pirelli technique is safe with low complication rates and high long-term patient satisfaction.

Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure.

Background:Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit.Methods:All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled.Results:Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure.Conclusion:Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often.Level of Evidence:Level II, prospective cohort study.

Use of mobile health technologies for postoperative care in paediatric surgery: A systematic review

Introduction Mobile health (mHealth) is the use of mobile communication devices such as smartphones, wireless patient monitoring devices and tablet computers to deliver health services. Paediatric surgery patient care could potentially benefit from these technologies. This systematic review summarises the current literature on the use of mHealth for postoperative care after children’s surgery. Methods Seven databases were searched by a senior medical librarian. Studies were included if they reported the use of mHealth systems for postoperative care for children <18 years old. Data extraction and risk of bias assessment were performed in duplicate. Results A total of 18 studies were included after screening. mHealth use was varied and included appointment or medication reminders, postoperative monitoring and postoperative instruction delivery. mHealth systems included texting systems and mobile applications, and were implemented for a wide range of surgical conditions and countries. Discussion Studies showed that mHealth systems can increase the postoperative follow-up appointment attendance rate (p < 0.001), decrease the rate of postoperative complications and returns to the emergency department and reliably monitor postoperative pain. mHealth systems were generally appreciated by patients. Most non-randomised and randomised studies had many methodological problems, including lack of appropriate control groups, lack of blinding and a tendency to devote more time to the care of the intervention group. mHealth systems have the potential to improve postoperative care, but the lack of high-quality research evaluating their impact calls for further studies exploring evidence-based mHealth implementation.

Perception on Healing Rate of Patients after Dental Extraction Regarding their Adherence to Post Operative Care

Objective: The understanding and adherence to postoperative care instructions are factors that influence the healing process of the patients after dental extraction. The aim of this study is to analyse the healing rate of the patients who strictly follow and who do not follow the postoperative instructions after dental extraction. Study design: One hundred patients with no medical complications who referred for non-surgical extraction were selected for this study. The patients were evaluated a week after extraction regarding their adherence to postoperative instructions. Results: 94 patients completed the study. Smoking, drinking of alcohol/ carbonated beverages are the main influential factors in which patients lack their adherence to post-operative care after dental extraction. Conclusion: The result of this study revealed no association of age, gender with the healing of the socket. However habit of smoking, consumption of alcohol associated with male gender highly influence the healing rate of patients after dental extraction.

Efficacy and Side Effects of Intracameral Moxifloxacin as Prophylaxis after Cataract Surgery

Purpose: To determine the efficacy of intracameral moxifloxacin at the end of cataract surgery.&#x0D; Methods: Retrospective record based study. Study was based on a consecutive case series of patients who had cataract surgery during 2009 through 2019 in the Department of Ophthalmology at Maharishi Vashishth State Medical College, Basti (India). Intracameral preservative free moxifloxacin injection was given at the conclusion of surgery to most patients. Standardized operating room and sterilization protocols were used. All The medical records were reviewed for the 8 weeks after surgery. Post-operative endophthalmitis rate was computed using the number of cases of postoperative endophthalmitis as the numerator and the number of cataract surgeries as the denominator.&#x0D; Results: Of the 10,108 surgeries performed during study period, 2012 (19.9%) involved intracameral moxifloxacin injection. No adverse drug reactions were reported from administration of intracameral antibiotics during the study period. The post-operative endophthalmitis rate in patient who had not received intracameral antibiotic injection was 0.06%. There was no endophthalmitis case reported in patients who had received intracameral moxifloxacin injection as prophylaxis.&#x0D; Conclusion: The results of this study support the use if intracameral moxifloxacin as a routine prophylaxis for endophthalmitis after cataract surgery. Especially in rural setting as the patients postoperative instruction compliance is poor and many patients are lost to follow-ups sue to different reasons.

Patient comprehension of hip arthroscopy: an investigation of health literacy.

Several studies have demonstrated that patients have significant impairments in understanding their injury and appropriate course of management in orthopedic surgery. The purpose of this investigation is to determine if patients are able to obtain a fundamental understanding of the requisite care associated with hip arthroscopy. Any patient who elected to have hip arthroscopy was prospectively recruited to participate in the study. All patients were told they would be asked to complete a questionnaire about their surgery and post-operative instructions. The answers to each question of the questionnaire they would receive at the first post-operative visit were verbally given to each patient during the pre-operative visit. They were also given a post-operative instruction sheet on the day of surgery that contained answers to the questionnaire. At the first post-operative visit, all patients were then asked to complete a multiple-choice questionnaire prior to seeing the surgeon. A total of 56 patients (14 males, 42 females) were enrolled. All patients reported they had read the post-operative instruction sheet. The average number of correct answers was 6.5 ± 0.6 (95% CI 6 − 7) out of 11 questions (59% correct response rate ±18% [95% CI 52 − 66%]). Although we made significant pre-operative oral and written efforts to help patients achieve an elementary level of health literacy regarding their forthcoming hip arthroscopy, many patients did not achieve satisfactory comprehension. Even with instruction and information given verbally and physically (via post-operative instruction sheet) patients did not obtain satisfactory comprehension of their surgical procedure. New ways (through video, simplified cartoons or verbal explanations) must be considered in educating patients concerning surgical procedures to increase comprehension and health literacy.