Postsurgical Wards Research Articles

Therapeutic Transformation through Healing Environment. Evaluation of Post Surgical Facilities Optimization in Selected Tertiary Healthcare Facilities in Post Covid-19 Kpk, Pakistan

Background: Healing environments in post-surgical wards are crucial for patient recovery. Despite their importance, there is a lack of such environments in many hospitals in Khyber Pukhtunkhwa (KPK), Pakistan, which affects patient outcomes. Objective: This study aimed to assess the presence of healing environment factors in post-surgical wards of selected tertiary care hospitals in KPK, Pakistan, and to determine patient satisfaction with these factors. Methods: The study utilized a purposive sampling technique to select 200 respondents from five tertiary care hospitals in KPK: Ayub Teaching Hospital (H1) in Abbottabad, Khyber Teaching Hospital (H2) in Peshawar, Government Lady Reading Teaching Hospital (H3) in Peshawar, Hayatabad Medical Complex (H4) in Peshawar, and Saidu Group of Teaching Hospitals (H5) in Saidu Shareef. Data were collected using structured questionnaires and observational studies conducted in November and December 2022. Observational data focused on five healing environment factors: access to nature, control and choices, positive distractions, social support, and environmental stressors. Ethical approval was obtained, and informed consent was secured from all participants. Data were analyzed using descriptive and inferential statistics to identify the presence and impact of healing environment factors. Results: The study revealed that social support was the only significantly present factor across all hospitals, largely due to cultural and religious practices rather than intentional design. Access to nature, control and choices, and positive distractions were notably lacking. Specifically, 60-70% of respondents reported the presence of social support, while only 20-30% indicated the presence of other healing environment factors. Environmental stressors were absent in two hospitals, indicating a variance in the quality of the healing environment across different settings. Conclusion: The absence of key healing environment factors in post-surgical wards highlights a significant gap in hospital design, impacting patient recovery and satisfaction. Integrating healing environment principles into hospital design can enhance patient outcomes and satisfaction. Future interventions should consider these elements to create more effective and supportive healthcare environments.

Comparison of Early and Delayed Feeding after Elective Gut Anastomosis

Objective: To compare the effects of early and delayed feeding after elective gut anastomosis in relation to a mean number of days of audible bowel sounds.Study Design: A cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Surgery, Combined Military th th Hospital (CMH), Rawalpindi, Pakistan, from 11th May 2019 to 10th November 2019.Methods: A total of 60 individuals undergoing gut anastomosis were divided into two groups. In group A, the NG tube was removed within 6 to 24 hours of surgery, and clear oral liquids (30ml/hour) were started. Oral fluids, including juices and soups on the other day after surgery, tailed by semisolid food at 3rd day, then regular food at 4 day and finally discharge at the 5 day. In group B, the NG tube was detached three to five days after the procedure, observing NG tube output <30-50cc daily. Then, patients were followed up in post-surgical wards for 48 hours. Patients were noted and informed of the time when bowel sounds were audible, the first flatus passed, and the first stool passed. Results: The mean age in group A was 40.23 ± 15.66 years, and in group B was 37.93 ± 15.23 years. Most of the patients, 31 (51.67%), were between 16 to 30 years of age. Out of 60 patients, 36 (60.0%) were males and 24 (40.0%) were females, with male to female ratio of 1.5:1. The mean number of days of audible bowel sounds in Group A (early feeding) was 1.57 ± 0.63 days while in Group B (delayed feeding) was 3.90 ± 0.76 days (p-value = 0.0001). Conclusion: This research established that the outcome of early feeding is better than the outcome of delayed feeding after elective gut anastomosis.
 How to cite this: Jabbar G, Ahmed MS, Malik AS, Akhtar S, Minhas FS, Makshoof MT, Shahid Z. Comparison of Early and Delayed Feeding After Elective Gut Anastomosis. Life and Science. 2024; 5(1): 101-106. doi: http://doi.org/10.37185/LnS.1.1.411

Surveillance of high-risk early postsurgical patients for real-time detection of complications using wireless monitoring (SHEPHERD study): results of a randomized multicenter stepped wedge cluster trial.

Vital signs measurements on the ward are performed intermittently. This could lead to failure to rapidly detect patients with deteriorating vital signs and worsens long-term outcome. The aim of this study was to test the hypothesis that continuous wireless monitoring of vital signs on the postsurgical ward improves patient outcome. In this prospective, multicenter, stepped-wedge cluster randomized study, patients in the control group received standard monitoring. The intervention group received continuous wireless monitoring of heart rate, respiratory rate and temperature on top of standard care. Automated alerts indicating vital signs deviation from baseline were sent to ward nurses, triggering the calculation of a full early warning score followed. The primary outcome was the occurrence of new disability three months after surgery. The study was terminated early (at 57% inclusion) due to COVID-19 restrictions. Therefore, only descriptive statistics are presented. A total of 747 patients were enrolled in this study and eligible for statistical analyses, 517 patients in the control group and 230 patients in the intervention group, the latter only from one hospital. New disability at three months after surgery occurred in 43.7% in the control group and in 39.1% in the intervention group (absolute difference 4.6%). This is the largest randomized controlled trial investigating continuous wireless monitoring in postoperative patients. While patients in the intervention group seemed to experience less (new) disability than patients in the control group, results remain inconclusive with regard to postoperative patient outcome due to premature study termination. ClinicalTrials.gov, ID: NCT02957825.

Assessing the Process of Written Informed Consent for Surgical Procedures among Inpatients: A Cross-sectional Study from a Tertiary Care Teaching Hospital in Southern India

Introduction: Informed Consent (IC) is a decision-making process wherein patients are provided with all necessary information regarding treatment to make an uncoerced, educated choice. There are gaps in the implementation of the IC process that need to be identified and addressed. Aim: To estimate the proportion of patients/surrogates who read, understood, and signed the IC form before undergoing surgical procedures; to identify the different healthcare team members involved in explaining the IC form; to evaluate the extent to which different components of the IC form were explained to patients/surrogates; and to determine the influence of the IC form on surgical decision-making, and the overall satisfaction with the IC process. Materials and Methods: This cross-sectional study was conducted at a tertiary care hospital in the Dakshina Kannada District of Southern India from April 2020 to March 2021. It included 100 adult patients admitted to the postsurgical wards of general surgery, orthopaedics, obstetrics and gynaecology, otorhinolaryngology, and ophthalmology. Ethical clearance was obtained from the Institutional Ethics Committee. The parameters studied included socio-demographic variables, administration of the IC form, details on the person explaining the IC form along with its content, and the influence of the IC form on decisionmaking, as well as overall satisfaction with the IC process. Data were collected using a predesigned questionnaire and analysed using descriptive statistics in Statistical Package for the Social Sciences (SPSS) version 27.0. Categorical variables were presented as frequencies and proportions, whereas continuous variables were presented as means and standard deviations. Results: All participants received the IC form; however, only 21% read, understood, and signed it. The explanation of the IC form was given to 59% of the patients, with only 15% of these explanations provided by the treating surgeon. The components of the IC form, such as the surgical procedure and its benefits, were explained to the majority of the patients; however, the risks of the surgical procedure and alternative options were explained to only 53% and 7% of patients, respectively. The IC form had a minor influence on surgical decision-making for 61% of patients, and 43% expressed satisfaction with the IC process. Conclusion: The study revealed that the implementation of IC was inadequate. Surgeons should provide and explain the IC form well in advance, allowing time for patients to read, understand, and clarify their doubts. Hospital Ethics Committees need to enforce strict adherence to IC guidelines to ensure informed decision-making

Capnography-An Essential Monitor, Everywhere: A Narrative Review.

Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.

Wireless patient monitoring and Efficacy Safety Score in postoperative treatment at the ward: evaluation of time consumption and usability

To evaluate objective time consumption and how nurses perceived introducing wireless patient monitoring (WPM) and a validated score on patient quality and safety, the Efficacy Safety Score (ESS), at a mixed surgery ward. After fulfilling a randomised controlled trial combining the ESS and WPM, we addressed time consumption and conducted a questionnaire survey among nurses who participated in the study. The questionnaire appraised the nurses’ evaluation of introducing these tools for postoperative management. Of 28 invited nurses, 24 responded to the questionnaire, and 92% reported the ESS and WPM-systems to increase patient safety and quality of care. 67% felt the intervention took extra time, but objective workload measurements revealed reduced time to 1/3 using ESS and WPM compared to standard manual assessment. Improved confidence when using the systems was reported by 83% and improved working situation by 75%. In a test situation to measure time consumption, the ESS and pre-attached WPM-systems require less time than the conventional standard of care, and may allow for more frequent clinical monitoring at the post-surgical ward. The combination of the ESS and the WPM systems was perceived as positive by participating nurses and further clinical development and research is warranted.

Outcome of total Laparoscopic Hysterectomy in adult females with Benign Uterine Pathology

Background: Laparoscopic hysterectomy literature showed varied results regarding outcome of laparoscopic hysterectomy. Moreover, there is no local evidence which could help us to determine the outcome of laparoscopic hysterectomy in females having uterine pathology. Methods: This descriptive case series was conducted in the Department of Obstetrics & Gynecology, Imran Idrees Teaching Hospital Sialkot for a period of 11 months from 1-1-2022 to 30-11-2022. Total 175 patients fulfilling selection criteria were enrolled in the study from emergency. Then all females underwent laparoscopic hysterectomy under general anesthesia. During surgery, operative time was noted. During surgery, bladder injury was noted if occurred (as per operational definition). Patients were shifted in post-surgical wards and were discharged from there after recovery. Results: In this study the main outcome variables were operative time, hospital stay and bladder damage. Mean operative time and hospital stay for patients who underwent laparoscopic hysterectomy was 170.93±49.18 minutes and 2.63±0.60 days. None of the patients had bladder damage. Practical implication: Laparoscopic hysterectomy is a safe, effective, and reproducible technique that can be adopted after completing a period of training required to standardize the technique. It has been associated with lesser blood loss, shorter stay in hospital, quick return to normal activity, and fewer surgical site infections when compared with abdominal hysterectomy. This approach must be established in our real, day-to-day clinical practice. Conclusion: Laparoscopic hysterectomy is an effective procedure for benign uterine pathology in terms of minimal complication rate (bladder injury), shorter hospital stay and an average mean operative time. Hence showing very promising results and a better outcome for the patients Keywords: Laparoscopic Hysterectomy, Benign Uterine Pathology, Operative time, Hospital Stay

To Assess the Outcome of Temporo-Mandibular Joint Arthrocentesis in the Treatment of Internal De-Arrangement of Temporo-Mandibular Joint

Background: The two joints connecting the jawbone to the skull are called the temporomandibular joints. The TMJs are another name for these joints (TMJ). It's a connection between the mandible (at the bottom of the skull) and the temporal bone (at the top of the skull). Internal derangement of the temporomandibular joint (TMJ) is a condition in which the disc in the TMJ is displaced out of its normal functional relationship with the mandibular condyle and the articular region of the temporal bone. The problem is within the TMJ, where it can cause serious problems. Pain from an internal condition can be effectively treated with arthrocentesis, or AC (ID). Objectives: The purpose of this study is to evaluate the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement. Study Design: Descriptive case series. Setting: Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore. Duration of Study: Six months after approval of synopsis i.e. 22-12-2018 to 22-06-2019 Methodology: 60 Patients matched the inclusion criteria selected from OPD of department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. Informed consent was obtained. Demographic details also obtained. Patients were undergone surgery by senior consultant under LA. After surgery, patients were shifted in post-surgical wards and discharged from there after 48 hours. Patients were advised to present after 1 week of surgery in OPD. After 1 week, patients were evaluated for postoperative maximal mouth opening. Patients were also asked for presence of postoperative pain by using VAS and score was noted (as per operational definition) by researcher himself. All this information was recorded through proforma (attached). Results: Total of 60 patients, 46.7 % ( n=28) were male and 53.3 %( n=32) were female, Mean age of patients was 37.38±15.11. Sixty percent, or n=36, of the patients were found to be between the ages of 18 and 35, and forty percent, or n=24, were found to be between the ages of 36 and 60. Mean duration of TMJ Internal derangement was 49.86±19.12. Mean maximal mouth opening was 35.55±3.51mm. (p-value 0.001) and mean post-operative pain was 2.23± 1.06. (P-value 0.001). Practical Implication: This study will help to understand the effectiveness of arthrocentesis of the temporomandibular joint in the management of temporomandibular joint internal derangement Conclusion: Finally, we decided that arthrocentesis is a straightforward, minimally invasive treatment. Internally dislocated temporomandibular joints (TMJ) can be corrected with this method. For those who have closed-lock internal derangement, TMJ arthrocentesis appears to be a risk-free alternative with a reduced potential for consequences. Keywords: Temporomandibular Joint, Arthrocentesis, Post-operative Pain, Derangement, Arthrocentesis, Arthroscopy.

SINGLE VERSUS MULTIPLE ARTERIAL GRAFTS: COMPARISON OF IN HOSPITAL MORTALITY

Even though not all findings have been equally positive, many retrospective studies seem to have shown an incremental survival improvement by increasing the number of arterial grafts. Multiple arterial (MultArt) grafting is only currently used in a small number of coronary arteries bypass grafting (CABG) surgeries, despite the convincing and comprehensive information in the published literature. The goal of the study is to compare the incidence of in-hospital mortality in patients following CABG with single versus multiple arterial grafts and to evaluate the frequency of single and multiple CABG arterial grafts in patients undergoing CABG for coronary arteries diseases (CAD). Following institutional review board permission, this descriptive case series was carried out at Jinnah Hospital's heart surgery department in Lahore. 250 patients receiving CABG under general anaesthesia were a part of this study. The quantity of arteries grafted was recorded during CABG. It was observed whether there were one or several arterial grafts. A single surgical team carried out every procedure, under general anaesthesia. Patients were moved to post-surgical wards after surgery. Following surgery, patients were monitored there for 7 days. In-hospital mortality is defined as when a patient dies while receiving treatment in the hospital. In this study, inpatient mortality affected 7 (or 5.9%) of patients treated with single grafts and just 1 (or 0.8%) of patients treated with multiple grafts (p=0.022). Patients who received single graft CABG had a considerably greater incidence of in-hospital mortality. The superiority of multiple arterial graft CABG in terms of lower hospital mortality rate was demonstrated by the study's findings.

Frequency of Delayed Onset of Traumatic Extradural Hematoma in Patients Presenting with Head Injuries

Objective: To assess the frequency of delayed traumatic extradural hematoma in patients presenting with head injuries in emergency of a tertiary care hospital. Materials and Methods: In this case series a total 125 patients who presented with head injury were included. All patients underwent assessment on Glasgow Coma Scale (GCS) and score was noted at baseline. Then patients were managed according to hospital protocol. After procedure, patients were shifted to post-surgical ward and were followed-up for 5 days. After 3 and 5 days, CT scan was done to assess presence or absence of extradural hematoma. Results: Mean age of patients in this study was 34.53±10.82 years. In this study 86 (68.8%) patients were male and 39 (31.2%) patients were female. In this study, 20 (16%) patients had delayed onset of Traumatic extradural hematoma in patients presenting with head injuries. DEDH was diagnosed in 45% patients having age 20-30 years, in 35% patients having age 31-40 years and in 20% patients having age >40 years. DEDH was diagnosed in 13 (65%) patients having baseline GCS 11-12, in 20% patients having GCS 8-10, in 15% patients having GCS 13-14. Conclusion: In this study frequency of delayed onset of Traumatic extradural hematoma in patients presenting with head injuries was 16%. Highest frequency (45%) was seen in the younger age group; 20-30 years, among male (65%) patients and those having baseline GCS in the range 11-12 (65%). Keywords: Traumatic extradural hematoma, delayed onset, head injury.

Comparison of Seroma Formation with Harmonic Scalpel Versus Monopolar Electrocautery in Axillary Dissection following Modified Radical Mastectomy

Background: Breast cancer is cancer that forms in the cells of the breasts. Despite of the emergence of the breast conservation technique modified Radical Mastectomy still remains the most commonly performed surgery for CA Breast. The Harmonic scalpel is a surgical instrument used to simultaneously cut and cauterize tissue. Aim: To compare the frequency of seroma formation with harmonic scalpel versus monopolar electrocautery in axillary dissection following modified radical mastectomy. Methods: This randomized control trial was conducted in the Department of General Surgery, Lahore General Hospital and Ghurki Trust Teaching Hospital, Lahore. 60 patients were enrolled. Two groups were made by applying lottery method. One group is treated with hormonic scalpel and other with electrocautery. All surgeries were done under general anesthesia by two surgical teams. After surgery, patients shifted in post-surgical wards and will be followed- up there for 7 days. Seroma formation was noted. All the collected data was entered and analyzed on SPSS version 21. Results: The mean age in harmonic scalpel group was 49.87± 8.67 years and in electrocautery group was 49.87± 8.67 years. The seroma formation in harmonic scalpel group was noted in 5(16.7%) patients whereas the seroma formation in electro cautery group was found in 11(36.7%) patients (p-value=0.080). Conclusion: This study concluded that the harmonic scalpel group showed lower rate of seroma formation than to electrocautery group, however statistically both groups are equally effective Keywords: Harmonic Scalpel, Seroma Formation, electrocautery

Prescribing in a pediatric hospital setting – Lost in translation?

ObjectivesTo determine parental understanding of directions on common pediatric prescription pharmacy labels and to identify enablers and barriers that affect interpretation of these labels. MethodsProspective qualitative descriptive study (July to August 2020) of 20 parents in post-surgical wards at a single Australian tertiary pediatric center. ResultsFour key themes emerged through inductive analysis of the interview transcripts: 1) the addition of specific directions, such as administration with/without food and treatment course duration were perceived to be beneficial; 2) explicit phrasing of dosing intervals and times were more easily interpreted; 3) the use of simpler and common terminology enhanced understanding of the directions; and 4) presentation of multiple-step directions (e.g. tapering regimens) in a simplified and more organized manner was identified as an enabler and was thought to reduce confusion. ConclusionDifferences in wording and presentation of pediatric prescription medication label directions led to variable interpretation by parents. Practise ImplicationsTherefore, there is a need for guidelines to standardize the wording of prescription medication advice labels. Findings from this study can be used to achieve this goal.

Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity

ObjectiveThe impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DesignA retrospective cohort study was carried out. SettingUniversity hospital. PatientsSurgical patients with severe comorbidities. InterventionThe outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. Variables of interestPoor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. ResultsNo significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71–2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37–10.9) and 1.67 (0.40–6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70–0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69–0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. ConclusionsPostoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.

Visual Improvement after Endoscopic Endonasal Transsphenoidal Excision of Pituitary Gland Tumor

Objective: To evaluate the frequency of improved visual acuity after Endoscopic Endonasal Transsphenoidal excision of pituitary gland tumor.Study Design: Descriptive case series.Materials and Methods: In our study, Pre-operative visual acuity was noted by using the Snellen’s chart. Then patients underwent pituitary gland excision though Endoscopic Endonasal Transsphenoidal approach under general anesthesia. After surgery, patients were shifted in postsurgical wards and then will be discharged from there and were examinedfor 3 months in OPD. Snellen’s chart was used to evaluate patents for visual acuity after 3 months by an experienced ophthalmologist having at least 4 years residency experience If visual acuity increased ? 1 line, then improved visual acuity was labeled.Results: Improved visual acuity after pituitary gland tumor excision was seen in 59(89.39%) patients. Age and gender of patients did not show any statistically significant association for improved visual acuity.Conclusions: Results of this study showed that pituitary gland tumor excision through Endoscopic Endonasal Transsphenoidal approach is effective in terms of visual acuity improvement. Our main objectives in pituitary surgery are protection and reinstatement of vision and this surgical approach give maximum cover to vision restoration.

Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity.

The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. A retrospective cohort study was carried out. University hospital. Surgical patients with severe comorbidities. The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70-0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.

In-hospital usability and feasibility evaluation of Panda, an app for the management of pain in children at home.

Postoperative pain in children is often poorly managed at home, leading to slower functional recovery, poor oral intake, sleep disturbances, and behavioral changes. Panda is a smartphone application (app) designed to support parents in assessing their child's pain and managing medications. The aim of this study was to evaluate the Panda app's usability and feasibility in hospital prior to testing the app at home. The study comprised two phases. Phase I evaluated Panda's usability with nurses, parents, and adolescents using simulated scenarios. Usability was measured by task completion rate, user error rates, and the Computer Systems Usability Questionnaire. Phase II evaluated Panda's feasibility by observing parents/guardians of pediatric patients using the app on the postsurgical ward. Feasibility was measured using response frequency and delay following app notifications from an audit trail of app function, and parental satisfaction from an interview. Feedback was used to guide iterative app improvements. In Phase I, 13 nurses, 12 parents, and 5 adolescents evaluated the app. A total of 103 usability issues were identified, analyzed, and addressed. In Phase II, 29 parents responded to a total of 151 app notifications, with 84% responding within 1hour in the final round of testing; 93% of participants reported the app was easy to use, and rated the app with a median [interquartile range] Computer Systems Usability Questionnaire score of 2 [1-4]. Significant barriers to use included lack of flexibility in the medication scheduling, low volume of alert sounds, and the extra time spent on medication safety checks. Panda's usability was improved and its feasibility demonstrated in the controlled hospital environment. The next step is to evaluate its feasibility for use at home.

DRUG UTILISATION REVIEW IN POSTOPERATIVEPATIENTS IN OBSTETRICS-GYNAECOLOGY AND SURGICAL GASTROENTEROLOGY DEPARTMENTS-A RETROSPECTVE STUDY

Objective: The main objectives of our study include classification, analysis and assessment of all the post-operative drugs present of our study.Methods: The current project being a retrospective drug utilization review 50 prescriptions from the post-surgical wards of obstetrics–gynaecology and surgical gastroenterology departments were collected and analysed.Results: All the data collected was classified, analysed and assessed based on the various factors and the results were people between the age group of 41-50 have undergone more number of surgeries 22%. Only 32% of all the prescriptions were found to have poly pharmacy, classification of all the prescribed drugs shows that the anti biotics were prescribed in the maximum number i.e. 152doses. Parenteral type of formulation was given in high number of doses up to 506 doses. Defined daily doses of all the W. H. O essential drug list medications were done. W. H. O prescribing indicators for all the drugs in our study was also calculated.Conclusion: Our study concludes that the antibiotic drug therapy was used as prophylaxis to prevent the bacterial infection.

Intensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study.

Patients are sometimes admitted to intensive care units (ICU) after elective noncardiac surgery for advanced monitoring and treatments not available on a general postsurgical ward. However, patterns of ICU utilization are poorly understood. Our aims were to assess the incidence and determinants of ICU utilization after elective noncardiac surgical procedures. Population-based cohort study included adult patients who underwent 13 types of major elective noncardiac surgical procedures between 2006 and 2014 in Ontario, Canada. Primary outcome was early admission to ICU within 24h after surgery. A prespecified analysis using multilevel logistic regression modeling separately examined patient- and hospital-level factors associated with early ICU admission within distinct groups of surgical procedures. Early ICU admission occurred in 9.6% of the included 541,524 patients. Patients admitted early to ICU showed higher median age (68 vs. 65years), burden of prehospital comorbidities (Charlson comorbidity index score ≥ 2, 33.1 vs. 10.4%), 30-day mortality rates (2.4 vs. 0.3%), and longer median postoperative hospital stays (6 vs. 4days) than patients admitted to a ward. There was wide variation in proportions of patients admitted early to ICU across different surgery types (0.9% for hysterectomy to 90.8% for open abdominal aortic aneurysm repair) with generally low 30-day mortality across procedures (0.1-2.8%). Within individual procedures, there was wide interhospital variation in the range of early ICU admission rates (hysterectomy 0.07-14.4%, lower gastrointestinal resection 1.3-95%, endovascular aortic aneurysm 1.3-95.2%). The individual hospital where surgery was performed accounted for a large proportion of the variation in early ICU admission rates, with the median odds ratio ranging from 2.3 for hysterectomy to 21.5 for endovascular aortic aneurysm. There is a wide variation in early ICU admission across and within surgical procedures. The individual hospital accounts for a large proportion of this variation. Further research is required to identify the basis for this variation and to develop better methods for allocating ICU resources for postoperative management of surgical patients.

The effects of intensive care environment on postoperative nightmare

We retrospectively investigated the incidence of postoperative nightmares and evaluated the impact of postoperative intensive care on the incidence of during subsequent hospital stay. To reduce the effect of selection bias, we compared the incidence of nightmares in propensity-matched pairs with postoperative management in ICUs or in surgical wards. This is a retrospective review of an institutional registry containing 21,606 anesthesia cases and was conducted with ethics board approval. Outcomes of surgical patients treated in ICUs and in postsurgical wards (ICU admission vs non ICU admission) were compared first for nightmares using the initial 12,508 patients. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (ICU admission) and controls (non ICU admission), yielding 642 matched patient pairs. The incidence rate of nightmares was compared as the primary outcome. Before adjusting patients' characteristics, ICU environment exposure increased the incidence of nightmares compared with non-ICU environment during subsequent hospital stay [ICU vs non-ICU: 101/718 (12.3%) vs 1147/10,542 (9.81%)]. The odds ratio (95% CIs) for ICU was 1.29 (1.03-1.61) for nightmares (p=0.022). After propensity score matching, however, an equal rate of nightmares occurred in the ICU environment exposure compared to the non-ICU environment [ICU vs non-ICU: 81/561 (12.6%) vs 73/569 (11.4%)]. The odds ratio and 95% CIs for ICU were 1.13 (0.80-1.58) for nightmares (p=0.54). The incidence of nightmares did not become more evident during subsequent hospital stay after ICU environment exposure.

An Ethnographic Observational Study to Evaluate and Optimize the Use of Respiratory Acoustic Monitoring in Children Receiving Postoperative Opioid Infusions.

Respiratory depression in children receiving postoperative opioid infusions is a significant risk because of the interindividual variability in analgesic requirement. Detection of respiratory depression (or apnea) in these children may be improved with the introduction of automated acoustic respiratory rate (RR) monitoring. However, early detection of adverse events must be balanced with the risk of alarm fatigue. Our objective was to evaluate the use of acoustic RR monitoring in children receiving opioid infusions on a postsurgical ward and identify the causes of false alarm and optimal alarm thresholds. A video ethnographic study was performed using an observational, mixed methods approach. After surgery, an acoustic RR sensor was placed on the participant's neck and attached to a Rad87 monitor. The monitor was networked with paging for alarms. Vital signs data and paging notification logs were obtained from the central monitoring system. Webcam videos of the participant, infusion pump, and Rad87 monitor were recorded, stored on a secure server, and subsequently analyzed by 2 research nurses to identify the cause of the alarm, response, and effectiveness. Alarms occurring within a 90-second window were grouped into a single-alarm response opportunity. Data from 49 patients (30 females) with median age 14 (range, 4.4-18.8) years were analyzed. The 896 bedside vital sign threshold alarms resulted in 160 alarm response opportunities (44 low RR, 74 high RR, and 42 low SpO2). In 141 periods (88% of total), for which video was available, 65% of alarms were deemed effective (followed by an alarm-related action within 10 minutes). Nurses were the sole responders in 55% of effective alarms and the patient or parent in 20%. Episodes of desaturation (SpO2 < 90%) were observed in 9 patients: At the time of the SpO2 paging trigger, the RR was >10 bpm in 6 of 9 patients. Based on all RR samples observed, the default alarm thresholds, to serve as a starting point for each patient, would be a low RR of 6 (>10 years of age) and 10 (4-9 years of age). In this study, the use of RR monitoring did not improve the detection of respiratory depression. An RR threshold, which would have been predictive of desaturations, would have resulted in an unacceptably high false alarm rate. Future research using a combination of variables (e.g., SpO2 and RR), or the measurement of tidal volumes, may be needed to improve patient safety in the postoperative ward.