Quality Of Postoperative Management Research Articles

ЭТИОЛОГИЧЕСКИЕ АСПЕКТЫ НОСОВЫХ КРОВОТЕЧЕНИЙ И АЛЬТЕРНАТИВНЫЕ СПОСОБЫ ИХ ОСТАНОВКИ

Objective: To study the etiology of epistaxis and to improve the mechanical ways to stop it. Methods: 354 patients with nose bleeding aged 6 months to 78 years were examined from 2,360 people who applied to the urgent ENT Department of the National Medical Center of the Republic Tajikistan, which was 15%. They conducted an otorhinolaryngological examination, evaluation of the general state, finding out the causes of nasal bleeding and all necessary measures to stop it. Results: Out of 354 patients, 339 (95.6%) provided the first emergency care in the urgent ENT Outpatient Department, and 15 (4.2%) hospitalized in ENT Department. Among general and local causes, cardiovascular disease, respiratory infections, chronic atrophic and subatrophic processes of nose mucous were identified. In 297 (83.4%) had a combination of those and other causes. The majority of patients (n=209; 58.5%) suffered from cardiovascular pathology, in particular hypertension and atherosclerosis, in 19 (5.5%) patients the nasal bleeding occurred during the period or after recently suffered acute respiratory infections. Only in 51 (14.4%) patients identified local causes of nasal bleeding, of which 15 patients were hospitalized in the ENT Department. Bleeding was stopped by the anterior nasal tamponade in 6 cases, the anterior and posterior tamponade – in 8 observations, and in one patient, with inefficiency of the posterior and anterior tamponade, ligation of external carotid artery was performed. An alternative method has been used as a rear tamponade for the first time using a device made from a conventional endotracheal tube with an inflatable cuff on the distal end. The method has proven to be more gentle and less traumatic, allowing keeping nasal breathing through the tube. This provides the best quality of postoperative management, and at times accelerates the rehabilitation process. Conclusions: The results show that the causes of nasal bleeding are most often caused by general somatic pathology and only in 14.4% of cases are associated with pathology of nasal cavity. The proposed alternative method of posterior tamponade has shown good results and the possibility of its wide practical application, especially in terms of first aid. Keywords: Epistaxis (nasal bleeding, nosebleed), posterior tamponade, endotracheal tube, hypertension, alternative method

Validity Test of the Indonesia Version of Revised American Pain Society Outcome Questionnaire (APS-POQ-R) to Evaluate Postoperative Management Quality

The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) is the most commonly used instrument to assess the quality of pain management in many countries but the validity and reliability of this instrument has not been verified in Indonesia. This is a descriptive, cross-sectional psychometric study to test the validity and reliability of Indonesia version of APS-POQ-R instrument to evaluate postoperative pain management quality. The APS-POQ-R was translated into Bahasa Indonesia according to international guidelines. The translation result was tested in 102 patients who underwent elective surgery at Cipto Mangunkusumo Hospital from March to April 2017. Coefficient Aiken V formula was used for content validity test while factor analysis and corrected item total correlation were used for construction validity test. Reliability was tested using internal consistency (Chronbach α). Aiken V formula showed the Indonesian version of APS-POQ-R was valid with score of 0.8–1 (scale V was ≥0.5). Factor analysis generated five main factors out of 18 instrument questions: activity and sleep disturbances, impact of pain to emotion, side effects, pain management perception, and pain scale. Construction validity test with corrected item total correlation showed all questions has good correlation, which ranged between 0.244–0.799 (correlation ≥0.3). Correlation between each factors of the Indonesian version of APS-POQ-R ranged 0.319–0.407. Internal consistency test showed the Indonesian version of APS-POQ-R was reliable with score of 0.663 (α > 0.5). The Indonesian version of APS-POQ-R is valid and reliable to measure postoperative pain management quality.

Surgical reduction of congenital hip dislocation.

Surgical reduction of congenital hip dislocation is technically challenging. In our practice, surgical reduction is usually reserved for patients who have failed non-operative treatment, which is the first-line strategy. However, primary surgery may be indicated if the dislocation is diagnosed late and can be performed until 8 years of age. The reduction step is crucial. It starts with painstaking exposure of the capsule. Identifying the lower part of the acetabulum is the key to accurate repositioning of the epiphysis. The main intra-articular procedures are resection of the ligament teres, adipose tissue within the acetabular cavity, and transverse acetabular ligament; and eversion of the radially incised limbus. In patients younger than 1 year of age, surgical reduction can be performed via the anterior approach or, in some cases, the obturator approach. No complementary steps are needed. If the diagnosis is made late, in contrast, reduction of the hip must be combined with corrective procedures on the femur and acetabulum designed to stabilise the reduction before the capsulorrhaphy, with the goal of optimising hip stability and minimising the risk of residual dysplasia. Femoral shortening and derotation osteotomy was classically reserved for children older than 3 years but has now been shown to be a useful and prudent procedure in younger patients. This osteotomy decreases pressure on the epiphysis, facilitates the reduction, and diminishes the risk of recurrence and avascular necrosis of the femoral head, which are the two dreaded complications. The outcome depends on the care directed to the procedure and on the quality of postoperative management.

Microsurgical reconstruction of the head and neck – Current concepts of maxillofacial surgery in Europe

IntroductionMicrovascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe. MethodsThe questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS). Results65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role. ConclusionWithin Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome.

An evaluation of postoperative epidural analgesia in acute pain service in an Indian cancer hospital (a preliminary experience of patient satisfaction survey)

Summary Quality improvement approaches have been used to evaluate pain management. The purpose of this study was two-fold: to obtain a baseline data of incidence of severity of pain and patient's level of satisfaction during postoperative period and also to evaluate the changes over time on pain severity, in pain interference with function, patient satisfaction, and time required to deliver the analgesics after implementation of pain protocols. Two hundred patients were administered a questionnaire adapted from American Pain Society's patient outcome questionnaire in a two-phased manner. One hundred patients were included in the survey during January 2004 and a year later a similar cohort of 100 were administered the same questionnaire to evaluate for changes in quality of postoperative management over time. This self-report survey found a significantly high patient satisfaction in the setting of significant postoperative pain. There is a statistically significant reduction in the severity of ‘average pain’ after implementation of pain protocols, however, it did not translate into improvement in the patient satisfaction. The issue of patient satisfaction is complex and needs a systematic program recommended by American Pain society's quality improvement guidelines.