Postoperative Care Of Patients Research Articles

HPB SO20 - Evaluating the Impact of Enhanced Recovery After Surgery Protocols Post Hepatectomy in Patients with Chronic Liver Disease: A Meta-Analysis

Abstract Background Defined criteria for the resectability of liver disease continue to be refined. In the era of enhanced recovery after surgery (ERAS), data regarding its safety and efficacy in specific patient populations is required. Patients with liver cirrhosis are particularly vulnerable, owing to both operative and peri-operative risk. However, the application of ERAS in cirrhotic patients undergoing hepatectomy is absent from the most recent ERAS Society Group recommendations from 2022. We present a meta-analysis assessing outcomes after liver resection in patients with cirrhosis following an ERAS protocol compared to standard post-operative care. Method A systematic literature search was performed using PubMed, Embase and Web of Science. Studies were included if comparing ERAS protocols versus standard post-operative care in patients undergoing liver resection in which more than 50% of the patient population had cirrhosis at time of surgery. The primary outcome analysed was overall complication rates with secondary outcomes of post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission and reoperation rates. Statistical analysis was performed using Review Manager by the Cochrane Collaboration. Results 930 records were screened for eligibility. Five articles were eligible for inclusion(ERAS n = 425 vs control group n = 423 patients). Cirrhotic patients enrolled in an ERAS program post-hepatectomy had a significantly reduced risk of overall complications (OR 0.45, 95% CI 0.33, 0.61, p<0.00001) and a shorter hospital stay when compared to standard post-operative care by 1.8 days (mean difference -1.83, 95% CI -2.22, -1.45, p<0.00001). No significant differences were noted in post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission or reoperation rates between the ERAS group and control. Conclusion Application of an ERAS protocol for patients undergoing liver resection is safe and feasible in cirrhotic patients. ERAS protocols were successful in significantly reducing overall complication rates and length of inpatient hospital stay, and did not negatively impact secondary post-operative outcomes or mortality. ERAS protocols should be reflected in future guidelines, specifically for cirrhotic patients undergoing hepatectomy, and additional research on the utility of ERAS in higher risk patients is encouraged.

BS SO07 - NHS Tertiary Centre Experience with Bariatric Tourism; A Call for National Registry

Abstract Background Bariatric surgery has demonstrated notable efficacy and is becoming an increasingly popular practice. Nonetheless, patients often opt for bariatric tourism due to the unaffordability of bariatric procedures or the lengthy waiting lists. The postoperative care for such patients not only imposes financial burdens on a different health system, necessitating costly interventions for complex cases but also affects the allocation of resources for patients receiving care in the public health services. A national guidance platform and registry are required to measure the impact of bariatric tourism on the modern NHS and plan future resource allocation. Method This is a retrospective review of patients referred to one of the bariatric units in the United Kingdom for complications following bariatric procedures abroad. Patient demographics, bariatric intervention, presenting complications, length of hospital stay and management received were recorded. Results Between 2022 and 2024, our unit admitted nine patients. Eight had sleeve gastrectomy in Turkey, and one had a gastric balloon in Thailand. In the sleeve group, five patients had intractable vomiting, one had small bowel ischemia, one leaked, and one had reactive hypoglycemia. The patient with the gastric balloon had vomiting and abdominal pain, leading to balloon removal. Three sleeve patients had a conversion to Roux-en-Y bypass, one is under investigation, and one is awaiting bypass surgery, one required three surgeries for small bowel ischemia, and one with a leak was treated with a pigtail and gastric stent. Conclusion Medical tourism for bariatric procedures is an appealing option for obese patients due to its affordability and shorter wait times. Patients typically receive brief pre-operative preparation and education in addition to a limited post-operative care. However, managing complex bariatric cases is expensive, necessitates extended hospital stays and nutritional and emotional support, and can only be done in specialised centres. It's important to create a national bariatric surgery guidance platform providing recognised centre details internationally and a national registry of bariatric tourism patients to assess the impact on the healthcare system and to plan for future resource allocation.

Perioperative Management of Opioid-Tolerant Patients: A Comprehensive Guide

The perioperative management of opioid-tolerant patients presents significant challenges, necessitating a tailored approach to pain management and the prevention of opioid-related complications. This review discusses the essential aspects of preoperative assessment, intraoperative strategies, and postoperative care for opioid-tolerant patients. Emphasis is placed on the continuation of baseline opioid therapy, the use of multimodal analgesia, and the importance of individualized opioid dosing to achieve effective pain control while minimizing the risk of withdrawal, respiratory depression, and opioid-induced hyperalgesia. The role of a multidisciplinary team in optimizing patient outcomes and the necessity of thorough discharge planning and follow-up are also highlighted. By addressing these critical factors, healthcare providers can ensure safe and effective perioperative care for opioid-tolerant patients.

Anesthetic Considerations for Endovascular Repair of the Thoracic Aorta.

Thoracic aorta pathologies, especially those of the ascending aorta and aortic arch, were traditionally approached via open surgical repair. This carries risk of ischemic end-organ damage and other complications. Endovascular repair of ascending aorta and aortic arch pathologies is becoming more successful and widespread, thereby posing numerous challenges to the anesthesiologist. This article reviews the anesthesia-pertinent pathophysiology, repair techniques, preoperative evaluation, intraoperative management, and postoperative care of patients presenting for endovascular repair of thoracic aorta pathologies.

Association Of Serum Prothrombin Index With Early Post-Operative Complications Following Liver Resection

Introduction: The Prothrombin Index (PI) is a critical measure of coagulation status, reflecting the liver's ability to synthesize clotting factors. In the context of liver resection, a procedure associated with a significant risk of bleeding and other complications, the assessment of PI becomes paramount. This study investigates the association between serum Prothrombin Index and early postoperative complications following liver resection. Methods: This Prospective observational study was conducted among the indoor patients of the Hepatobiliary unit of the surgery department in Dhaka Medical College Hospital, from 1st January 2023 to 29th December 2023. All patients admitted to the hepatobiliary unit of the department of surgery, Dhaka Medical College Hospital were considered as the study population. A total of 40 patients were selected as study subjects through a purposive sampling technique. Data were analyzed by Statistical Package for Social Sciences (SPSS) version 20.0. Result: In the early postoperative period, the association between prothrombin index (PI) and various complications was assessed. Regarding bile leak, no statistically significant association was observed, with the probability of bile leak being 0.237 for patients with a PI <50%. In contrast, a significant association was found between PI and postoperative bleeding, where a PI <50% showed a probability of 0.04 for hemorrhage, making this result statistically significant. Lastly, the association between PI and sepsis revealed no significant findings, with a probability of 0.479 for sepsis in patients with a PI <50%. Overall, a lower PI was significantly linked to an increased risk of postoperative bleeding, but not to bile leak or sepsis. Conclusion: The study findings highlight the clinical importance of assessing both the initial and postoperative Prothrombin Index concerning outcomes following liver resection. Consequently, utilizing the initial and early postoperative Prothrombin Index as a clinical parameter can enhance the optimization of postoperative patient care.

Post-operative care for patients following surgical treatment of lymphedema.

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research.

Volume changes in the contralateral submandibular gland following unilateral gland excision in oral cancer patients

BackgroundThe effects of unilateral submandibular gland excision on the size of the contralateral gland are not well understood, with no human studies reported to date. This study aims to investigate the impact of unilateral submandibular gland excision on the contralateral gland’s size, providing insights into compensatory mechanisms and their clinical implications.MethodThis retrospective study involved patients with oral cancer who underwent unilateral submandibular gland excision and ipsilateral neck dissection at Gangneung-Wonju National University Dental Hospital between 2008 and 2023. Patients were included if they had preoperative and follow-up 3D radiological images. The contralateral submandibular gland volume was measured using 3D Slicer software on preoperative, post-operative, and follow-up radiographic data.ResultsThe mean volume change of the contralateral submandibular gland was 1.35 ± 2.06 cm3, with a mean change ratio of 1.18 ± 0.24. These changes were statistically significant (p = 0.006). Other factors such as age, gender, and radiotherapy did not significantly affect the volume change ratio (p > 0.05).ConclusionThe contralateral submandibular gland exhibits a statistically significant increase in volume following unilateral gland excision, indicating compensatory hypertrophy. This morphological adaptation should be considered in post-operative care and surgical planning for oral cancer patients to optimize outcomes.

Reducing Opioid Consumption and Length of Stay After Bariatric Surgery: A Nonpharmacologic ERAS Intervention Bundle

PurposeTo reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle. DesignEvidence-based practice project. MethodsWe developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients. The bundle consisted of early ambulation, immediate initiation and prolonged use of oxygenation, prevention of nausea and vomiting, frequent use of incentive spirometry, and application of ice packs to surgical sites. The two project outcomes were opioid consumption and patient LOS. We used descriptive statistics to summarize opioid consumption and LOS among surgical bariatric patients at baseline and post intervention and independent samples t tests to determine the statistical significance of pre- or post-LOS changes. FindingsAfter implementing the ERAS bundle in 31 bariatric surgical patients, we found that the percentage of patients given an opioid substantially decreased by 13.8%, with both fentanyl and hydromorphone (Dilaudid) consumption meaningfully decreasing by 11.0% and 25.6%, respectively. The average LOS significantly decreased (P = .015) by 23 minutes per patient following the intervention, from 1 hour and 58 minutes to 1 hour and 35 minutes, representing a 19.5% reduction in total patient time in the PACU. ConclusionsUse of a nonpharmacologic ERAS bundle and standardizing postoperative care decreased overall PACU bariatric surgical patient opioid consumption and significantly reduced PACU LOS. Optimizing pain management for bariatric patients in the PACU could lead to improved pain control and reduced reliance on opioids during their entire hospital stay, enhancing health care outcomes and improving patient safety. Perioperative leaders and educators can use our example to develop initiatives that decrease opioid use and LOS to improve care for the high-acuity bariatric patient population.

PDOC-10 LIMITATIONS IN POST OPERATIVE- ADJUVANT CARE OF PATIENTS WITH BRAIN TUMOURS-A CASE OF SUPRATENTORIAL MEDULLOBLASTOMA IN A PAEDIATRIC PATIENT

Abstract OBJECTIVE To highlight the challenges and limitations in accessing post-operative adjuvant care of patients with brain tumours in Zimbabwe and implications on patient outcomes and to discuss potential strategies to overcome these challenges. METHODS This is a case report on a 6 year old patient with a supratentorial medulloblastoma to demonstrate the challenges encountered on accessing post-operative adjuvant care at a Central hospital in Harare. RESULTS The patient had a near total resection of the tumour done and was managed in the Intensive care unit for 1 week. HE was discharged to the general ward for another week and eventually referred to the paediatric oncologists after a histological diagnosis of a supratentorial medulloblastoma was made. Patient received cycles of chemotherapy but failed to raise money for adjuvant radiotherapy. Patient returned 5 months later with the tumour having recurred. CONCLUSION Limitations in post-operative adjuvant care may have a negative impact on the overall patient outcomes, in this case lack of access to radiotherapy. Medulloblastomas are responsive to radiotherapy and their prognosis improves significantly with a combination of surgical resection and radiotherapy. Addressing these limitations at different levels involving government and non-governmental organizations helps in mitigating inaccessibility of radiotherapy to radio-sensitive brain tumours patients after surgical resection. This case report brings out the urgent need to implement cheaper and sustainable options to address challenges in post-operative adjuvant care in order to get good patient outcomes.

Bat Ear Correction Steps and Outcomes for Better Life Support.

An unusually projecting human ear is known as a prominent ear, otapostasis, or bat ear. It might be both bilateral and unilateral. The scapha and antihelix of the big concha are not well formed. It is the outcome of cartilage deformity that occurred during early ear development in utero. After the child reaches five years old, the abnormality can be corrected at any time. In order to prevent psychological suffering, the procedure should ideally be performed as soon as possible. Otoplasty correction is reshaping the ear cartilage to bring the ear closer to the side of the head. The cartilage is reshaped, but the skin is left in place. Hearing remains unaffected by the operation. It is mainly done for aesthetic reasons. Although they are uncommon, the post-operative consequences from the operation include hematoma development, keloid formation, infection, and asymmetry in the ears. Otoplasty is a cosmetic operation that involves permanent sutures to alter the size, shape, or location of the ear. The main purpose of otoplasty is to treat promin auris, or bulging ears. Promin auris, the principal indication for otoplasty, is the subject of this review. The indications, contraindications, and method utilized in otoplasty are reviewed in this exercise, which also emphasizes the need of pre- and post-operative care for patients having this surgery. Otoplasty results are generally lifelong and will improve the self-confidence. The goals of otoplasties are to make the ears appear more natural in comparison to the head and help with the overall contour of the ears. Final ear surgery results will be visible after a two week recovery period, with small improvements appearing for up to 12 months post-procedure. A proper understanding of the diagnosis, indications, and surgical techniques will lead to positive outcomes in otoplasty.

Community paramedicine program and outcomes of referred coronary artery bypass grafting patients.

Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure. A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care. There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar. Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals. This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

Development and validation of a nomogram for predicting critical respiratory events during early anesthesia recovery in elderly patients

BackgroundElderly patients undergoing recovery from general anesthesia face a heightened risk of critical respiratory events (CREs). Despite this, there is a notable absence of effective predictive tools tailored to this specific demographic. This study aims to develop and validate a predictive model (nomogram) to address this gap. CREs pose significant risks to elderly patients during the recovery phase from general anesthesia, making it an important issue in perioperative care. With the increasing aging population and the complexity of surgical procedures, it is crucial to develop effective predictive tools to improve patient outcomes and ensure patient safety during post-anesthesia care unit (PACU) recovery.MethodsA total of 324 elderly patients who underwent elective general anesthesia in a grade A tertiary hospital from January 2023 to June 2023 were enrolled. Risk factors were identified using least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was constructed and represented as a nomogram. Internal validation of the model was performed using Bootstrapping. This study followed the TRIPOD checklist for reporting.ResultsThe indicators included in the nomogram were frailty, snoring, patient-controlled intravenous analgesia (PCIA), emergency delirium and cough intensity at extubation. The diagnostic performance of the nomogram model was satisfactory, with AUC values of 0.990 and 0.981 for the training set and internal validation set, respectively. The optimal cutoff value was determined to be 0.22, based on a Youden index of 0.911. The F1-score was 0.927, and the MCC was 0.896. The calibration curve, Brier score (0.046), and HL test demonstrated acceptable consistency between the predicted and actual results. DCA revealed high net benefits of the nomogram prediction across all threshold probabilities.ConclusionsThis study developed and validated a nomogram to identify elderly patients in the PACU who are at higher risk of CREs. The identified predictive factors included frailty condition, snoring syndrome, PCIA, emergency delirium, and cough intensity at extubation. By identifying patients at higher risk of CREs early on, medical professionals can implement targeted strategies to mitigate the occurrence of complications and provide better postoperative care for elderly patients recovering from general anesthesia.

Current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province, China: A multicenter cross-sectional study

BackgroundThe postoperative care behavior of elderly osteoporotic fracture patients has a significant impact on their prognosis and rehabilitation; thus, it is critical to completely comprehend their current state of care before optimizing postoperative care strategies. AimsTo determine the current status of postoperative care for elderly osteoporotic fracture patients in Jiangsu Province. MethodsFrom October to December 2023, 669 elderly postoperative patients with osteoporotic fractures were recruited for a cross-sectional study via convenience sampling and a self-designed questionnaire from 21 hospitals in seven urban areas in Jiangsu Province. ResultsA total of 800 questionnaires were distributed, and 709 questionnaires were recovered, for a return rate of 88.6%. The postoperative support and care received by the patients were mostly by their children and spouses, and the postoperative health education knowledge received by the patients was mostly about fracture-related knowledge and precautions for the use of medications. Health education methods were mainly conducted by medical staff explanations and health brochures; only 45.3% of the patients were treated with anti-osteoporosis therapy. ConclusionsThe current status of postoperative care for osteoporotic fracture patients in Jiangsu Province varies somewhat according to geographic location, hospital level and other factors, with tertiary hospitals and more economically developed areas having relatively better care outcomes. For in-hospital care, it is necessary to improve the content and methods of in-hospital education. For out-of-hospital care, it is necessary to raise the level of awareness of anti-osteoporosis treatment and the prevention and treatment of re-fractures, and to improve hospital-community referral services.

Nature and Determinants of Fear of Cancer Recurrence After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Cross-Sectional Study.

Gastric cancer is one of the most prevalent tumors in China and other countries, with high morbidity and mortality. Fear of cancer recurrence is common among cancer survivors. Fear of cancer recurrence experiences and psychological interventions have been investigated in breast and other cancers. However, this phenomenon and associated factors have not been evaluated in early gastric cancer survivors in China. The objective of this study was to investigate the nature of fear of cancer recurrence and influencing factors in Chinese patients with early gastric cancer treated with endoscopic submucosal dissection. This cross-sectional study in two centers included 312 early gastric cancer patients who answered self-report questionnaires and were treated with endoscopic submucosal dissection between June 2022 and May 2023 to assess fear of cancer recurrence. Gender, family history of gastrointestinal tumor, tumor recurrence, Helicobacter pylori infection, disease perception, and self-perceived burden were significant factors influencing fear of cancer recurrence (p < .05). More than half of early gastric cancer patients have fear of cancer recurrence, and how to deal with it has become a key issue in the postoperative care of patients. Medical professionals should address these factors to reduce fear of cancer recurrence in at-risk patients.

Comprehensive evaluation of Chinese herbal compound prescriptions for postoperative spinal cord injury: A network meta-analysis of randomized controlled trials

BackgroundSpinal cord injury (SCI) is a catastrophic condition associated with spinal nerve damage, which can lead to complete or partial loss of sensory and motor functions. Chinese herbal compound prescriptions (CHCP) have shown varying degrees of therapeutic effects on spinal cord injuries. However, there is a significant lack of clinical evidence-based research to substantiate these effects. PurposeThis study aims to thoroughly assess the viability of CHCPs in postoperative SCI through network meta-analysis. MethodsComputer searches were conducted across multiple databases, including PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM, from their inception until May 2024. The meta-analysis adhered to the PRISMA guidelines and was registered in the PROSPERO database (CRD42023462686). A network meta-analysis was performed using the BUGSnet software package via R. Study design: A network meta-analysis of randomized clinical trials (RCTs). ResultsA total of 26 RCTs involving 1848 patients were ultimately included. The network meta-analysis revealed the effectiveness in improving ASIA motor score as follows: “HQGZD” > “Other Decoctions” > “BYHWD” > “TDHXD” > “THCQD” > “Surgery”. For ASIA sensory score, the effectiveness ranking was: “HQGZD” > “Other Decoctions” > “BYHWD” > “TDHXD” > “THCQD” > “Surgery”. Additionally, the experimental group had a higher ADL score compared to the control group, with a statistically difference [SMD = 1.08, 95 % CI = (0.88, 1.27), p < 0.05]. The experimental group had fewer adverse events compared to the control group, with a statistically difference [RR = 0.41, 95 % CI (0.22, 0.78), p < 0.05]. ConclusionThe findings suggest that CHCP can mprove postoperative ASIA motor and sensory scores, enhance ADL scores, and reduce adverse events following SCI surgery. Specifically, combining surgery with Huangqi Guizhi Wuwu Decoction or Buyang Huanwu Decoction may provide superior therapeutic effects in SCI treatment. Integrating CHCP into postoperative care for SCI patients may offer potential benefits.

Innovative integration of lung ultrasound and wearable monitoring for predicting pulmonary complications in colorectal surgery: A prospective study.

Postoperative pulmonary complications (PPCs) are common in patients who undergo colorectal surgery. Studies have focused on how to accurately diagnose and reduce the incidence of PPCs. Lung ultrasound has been proven to be useful in preoperative monitoring and postoperative care after cardiopulmonary surgery. However, lung ultrasound has not been studied in abdominal surgeries and has not been used with wearable devices to evaluate the influence of postoperative ambulation on the incidence of PPCs. To investigate the relationship between lung ultrasound scores, PPCs, and postoperative physical activity levels in patients who underwent colorectal surgery. In this prospective observational study conducted from November 1, 2019 to August 1, 2020, patients who underwent colorectal surgery underwent daily bedside ultrasonography from the day before surgery to postoperative day (POD) 5. Lung ultrasound scores and PPCs were recorded and analyzed to investigate their relationship. Pedometer bracelets measured the daily movement distance for 5 days post-surgery, and the correlation between postoperative activity levels and lung ultrasound scores was examined. Thirteen cases of PPCs was observed in the cohort of 101 patients. The mean (standard deviation) peak lung ultrasound score was 5.32 (2.52). Patients with a lung ultrasound score of ≥ 6 constituted the high-risk group. High-risk lung ultrasound scores were associated with an increased incidence of PPCs after colorectal surgery (logistic regression coefficient, 1.715; odds ratio, 5.556). Postoperative movement distance was negatively associated with the lung ultrasound scores [Spearman's rank correlation coefficient (r), -0.356, P < 0.05]. Lung ultrasound effectively evaluates pulmonary condition post-colorectal surgery. Early ambulation and respiratory exercises in the initial two PODs will reduce PPCs and optimize postoperative care in patients undergoing colorectal surgery.

Effectiveness of the IKAP Nursing Mode in Improving the Prognosis of Patients after Spontaneous Pneumothorax Single-Hole Thoracoscopy: Retrospective Study

Purpose: This study aimed to evaluate the effectiveness of the information-knowledge-attitude-practice (IKAP) nursing mode in improving the prognosis of patients after spontaneous pneumothorax single-hole thoracoscopy. Methods: A retrospective analysis was conducted on the clinical data of patients with spontaneous pneumothorax who underwent single-hole thoracoscopy from June 2020 to June 2023. Among these patients, 59 received traditional nursing care and 52 received care under the IKAP nursing mode. Data on patient demographics, intraoperative variables, rehabilitation time, complications, adverse events, pain scores, quality of life, psychological status, and sleep quality 72 hours after surgery were collected and compared between the two groups. Results: Compared with the traditional nursing group, the IKAP nursing group exhibited significantly shorter chest tube retention time (55.46 ± 9.26 hours vs. 60.74 ± 10.13 hours; p = 0.005), gas stop escape time (50.92 ± 8.73 hours vs. 55.13 ± 7.68 hours; p = 0.009), and overall hospitalization time (4.15 ± 1.53 days vs. 5.17 ± 2.46 days; p = 0.009); significantly lower rates of pleural infection (1.92% vs. 16.95%; p = 0.008) and bleeding events (1.92% vs. 16.95%; p = 0.008); and lower pain scores at 12 hours (4.56 ± 1.57 vs. 5.19 ± 1.14; p = 0.020) and 72 hours after surgery (2.84 ± 0.48 vs. 3.07 ± 0.45; p = 0.010). The patients under the IKAP nursing care also exhibited statistically significant improvements in somatization (81.72 ± 3.98 vs. 79.53 ± 4.02, p = 0.005) and emotion management (81.14 ± 5.26 vs. 78.10 ± 4.78, p = 0.002) compared with those under traditional nursing. Significantly lower levels of anxiety (10.37 ± 2.21 vs. 11.82 ± 2.53, p = 0.002), depression (9.37 ± 2.06 vs. 10.61 ± 2.35, p = 0.004), and stress (21.68 ± 4.16 vs. 23.54 ± 4.78, p = 0.032) were observed under the IKAP nursing mode compared with those under traditional nursing at 72 hours post-surgery. The IKAP nursing group exhibited better sleep quality as measured by the Pittsburgh sleep quality index (PSQI) score (7.94 ± 1.56 vs. 8.64 ± 1.95, p = 0.041) but longer sleep duration (7.45 ± 1.37 vs. 6.72 ± 1.29, p = 0.005) compared with the traditional nursing group. Conclusion: Compared with traditional nursing, the IKAP nursing mode demonstrated favorable outcomes including shorter rehabilitation times, reduced rates of postoperative complications, and improved pain management, emotion management, and sleep quality. This comprehensive and patient-centered approach shows potential to optimize the postoperative care, outcomes, and overall prognosis of patients undergoing thoracoscopy for spontaneous pneumothorax. Owing to its retrospective nature, the potential for selection bias and confounding variables in this work cannot be discounted. Future prospective studies with large and diverse cohorts are warranted to validate these findings.

An Analysis of Ocular Biometrics: A Comprehensive Retrospective Study in a Large Cohort of Pediatric Cataract Patients.

Objectives: This study aims to provide a comprehensive analysis of ocular biometric parameters in pediatric patients with cataracts to optimize surgical outcomes. By evaluating various biometric data, we seek to enhance the decision-making process for intraocular lens (IOL) placement, particularly with advanced technologies like femtosecond lasers. Methods: This retrospective comparative study included pediatric patients with cataracts who underwent ocular biometric measurements and cataract extraction with anterior vitrectomy at the Medical University of Vienna between January 2019 and December 2021. Parameters measured included corneal diameter (CD), axial length (AL), corneal thickness (CT) and flat and steep keratometry (Kf and Ks). The study explored the correlations between these parameters and IOL placement. Results: A total of 136 eyes from 68 pediatric patients were included in the study. Significant positive correlations were found between corneal diameter, age and AL. The mean CD was 11.4 mm, mean AL was 19.5 mm, CT was 581.2 ± 51.8 µm, Kf was 7.76 ± 0.55 mm and Ks 7.41 ± 0.59 mm, respectively. Older pediatric patients with larger corneal diameters and longer ALs were more likely to receive in-the-bag IOL implantation. Conversely, younger patients often required alternative IOL placements or remained aphakic. Our data indicated that over 95% of the study population and all patients aged one year and older had a corneal diameter of 10 mm or larger. Conclusions: Detailed ocular biometric analysis is crucial for optimizing both surgical outcomes and postoperative care in pediatric cataract patients. The positive correlations between CD, age and AL underline the importance of individualized surgical planning tailored to each patient's unique anatomical features. Additionally, our findings suggest that the use of a femtosecond laser is both feasible and safe for pediatric patients aged one year and older, potentially offering enhanced surgical precision and improved outcomes.

The impact of the doctor-nurse-patient workshop transitional care model on the post-operative quality of life of patients with laryngeal cancer.

The aim of this study is to assess the efficacy of the doctor-nurse-patient workshop transitional care model on post-operative care for patients with laryngeal cancer and its influence on quality of life. A total of 68 patients with laryngeal cancer who underwent surgical treatment at the hospital between 2021 and 2022 were included in the study. The patients were divided into two groups, a control group and a research group, each consisting of 34 patients, based on the chronological sequence of their surgeries. Patients in the control group received standard nursing care, while those in the research group received the doctor-nurse-patient workshop transitional care model in addition to standard nursing care. After 2months of care, levels of albumin (ALB), total protein (TP), hemoglobin (Hb), and quality of life scores (measured using the Quality of Life Instrument for Head and Neck Cancer, QLICP-HN) were compared between the two groups. Additionally, the incidence of adverse events during the recovery period was assessed and compared between the two groups. Following 2months of care, patients in the research group exhibited elevated ALB, TP, and Hb levels compared to those in the control group. Additionally, the average QLICP-HN scores were higher in the research group, while the incidence of adverse events was lower compared to the control group. Implementing the doctor-nurse-patient workshop transitional care model in home care for patients with laryngeal cancer can enhance their nutritional status post-surgery and improve their quality of life during home rehabilitation. This, in turn, leads to a reduction in the incidence of adverse events and complications during the recovery period.

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models

BackgroundThoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population.MethodsA retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity.ResultsGender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week.ConclusionsThe study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.