Preparation Of Patient For Surgery Research Articles

Management of surgical diseases of Primary Hyperparathyroidism: indications of the United Italian Society of Endocrine Surgery (SIUEC).

A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in parathyroid surgery published in 2014, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 12 members of the SIUEC highly trained and experienced in thyroid and parathyroid surgery. The main topics concern diagnostic test and localization studies, mode of admission and waiting time, therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications), hospital discharge and patient information, outpatient care and follow-up, outpatient initial management of patients with pHPT.

Effect of various pharmacotherapy regimens on the state of carbohydrate metabolism in patients with urination disorders

Aim. To evaluate the efficacy and safety of various pharmacotherapy regimens in patients with urination disorders and type 2 diabetes mellitus during their preparation for surgery.Materials and methods. In total, 130 people (56 men and 74 women) aged from 18 to 81 years (average 65 years) were included in the research. All the patients were on standardized hypoglycemic therapy in combination with alpha1-blockers (doxazosin, terazosin) and vitamin-like drugs (alpha-lipoic acid, levocarnitine). Patients were divided into male and female subgroups, as well as into age subgroups, including under 65 years and over 65 years. Tabular methods of assessing the clinical symptoms of urinary disorders were used, along with instrumental, laboratory, and statistical methods (Mann-Whitney test, Spearman rank correlation coefficient).Results. The duration of therapy averaged 16± 2 months. The observation found that alpha1-blockers lead to a number of positive changes in the composition of carbohydrate metabolism, i.e., the level of serum glucose and insulin. In the general observation group, a significant decrease in blood glucose from 6.64 to 6.27 mmol/L, insulin from 18.07 to 14.03 mU/mL, and C-peptide from 3.67 to 2.98 ng/mL was detected. In the male subgroup, glucose levels decreased from 6.45 to 6.00 mmol/L, insulin from 18.92 to 13.99 mU/mL, and C-peptide from 3.76 to 2.97 ng/mL. In the female subgroup, blood glucose levels decreased from 6.98 to 6.77 mmol/L, insulin from 16.41 to 14.1 mU/mL, and C-peptide from 3.51 to 2.99 ng/mL. In the group of patients younger than 65 years of age, a decrease in glucose from 6.22 to 5.93 mmol/L, insulin from 17.87 to 14.36 mU/mL, and C-peptide from 3.49 to 3.01 ng/mL were also observed. In the group of patients older than 65 years of age, similar dynamics of the above parameters was established.Conclusions. The data obtained suggest that alpha1-blockers in combination with vitamin-like drugs contribute to reducing the level of serum glucose, insulin, and C-peptide during a long-term (at least 1 year) therapy, which may be promising in the correction of metabolic disorders during preparation of patients for surgery.

Preoperative anaesthesia assessment and patient preparation for surgery: update and a review

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. The “Helsinki Declaration on Patient Safety in Anaesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anaesthesiologists. This declaration has been accepted by all the European Societies of Anaesthesiology and stipulates that all institutions providing perioperative anaesthesia care to patients should design protocols to guide perioperative patient management. The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting is discussed. The anaesthesiologist’s legal responsibility, and patients’ views in the preoperative process are also considered. A thorough clinical preoperative evaluation of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care.

Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC)

A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.

Nurses' viewpoints on factors affecting ostomy care: A qualitative content analysis.

Ostomy plays an important role in management of medical conditions, especially postoperative status of colorectal and bladder cancers. Nurses who have the highest contact level with these patients, face many situations while providing care and need to acquire adequate knowledge and practice responding to patients' needs. The aim of this study was to explore the lived experiences of nurses in caring of abdominal ostomy patients. A qualitative content analysis study. In this qualitative content analysis study, 17 participants were selected using purposeful sampling method and data were collected through in-depth and semi-structured interviews. Data analysis was done using conventional content analysis method. Analysis of the findings led to the emergence of 78 sub-subcategories, 20 subcategories and seven main themes, including 'Inefficient educational system', 'Nurse Characteristics', 'Workplace challenges', 'Nature of ostomy care', ' Counseling and preparation of patients for surgery', 'Acquaintance with ostomy complications', and 'Proper planning of patient education'. Results showed that nurses in surgical wards provide non-special ostomy care due to lack of sufficient knowledge and skills and absence of up-to-date and local clinical guidelines which is vital to provide evidence-based scientific care and avoid unfounded and arbitrary care.

Preparing patients for surgery: Perioperative care and general practice

Perioperative care challenges the integration of community and hospital multidisciplinary teams to prepare patients for surgery from the moment a patient considers undergoing an operation to the later recovery from surgery. Primary care has a role in the perioperative pathway, for example, in the management of long-term conditions and in identifying treatable pathology ahead of surgery. There are many factors beyond the control of primary care that compromise the optimisation of patients’ long-term conditions or even their general health ahead of planned surgery. However, there may be opportunities to optimise patients’ relevant comorbidities when surgery is first contemplated during the increasingly protracted period before surgery. Preoperative assessment clinics (POACs) are integral to perioperative care and present an opportunity to address specific issues relating to the day of surgery and to answer patients’ questions. Often POACs see patients with long-term conditions not optimised for surgery. This is a late, and less than ideal, opportunity to prepare patients for surgery. This article seeks to identify earlier opportunities to effectively improve the preparation of patients for surgery and to avoid postponement of surgery.

Total Joint Arthroplasty Training (Prehabilitation and Rehabilitation) in Lower Extremity Arthroplasty

Lower extremity total joint arthroplasty (TJA) has an established track record of success and a subset of patients who fail to experience desired improvements. Current TJA success can be attributed to refined surgical techniques, improved preparation of patients for surgery, and enhanced postoperative recovery protocols. One aspect of preoperative patient preparation and enhanced postoperative recovery includes training regimens intended to prepare patients for TJA and facilitate TJA functional recovery (often referred to as using the jargon prehabilitation and rehabilitation). The importance of prehabilitation and rehabilitation is open to debate because of historically insufficient and inconsistent evidence. This review aims to provide direction for future investigative efforts by presenting an overview of current preoperative and postoperative TJA training/exercise programs within the framework of utility, timing, form, setting, and cost.

Implementation of electronic messaging protocol for pediatric urology preoperative scheduling: A pilot study

Preparing patients for surgery is a task healthcare organizations strive to optimize. Electronic messaging (EM) provides an opportunity for streamlining components of this arduous process. Our study aims to evaluate our early experience in utilizing EM to provide preoperative information to pediatric urology patients. To assess the effectiveness of EM in preparing patients for pediatric urologic surgery. This study compared a 6-week pilot program of EM (Figure1) with traditional nurse phone calls (NPC) in preoperative instruction of pediatric urology patients. The same preoperative instructional information was provided via either source. Data collected included time and resources used by the healthcare system and patient/parent satisfaction. The EM group included 98 patients, while the NPC group included 212 patients. Case cancellation rate between the two cohorts was similar, with a 6.67% cancellation rate in the EM cohort and a 10.55% cancellation rate in the NPC cohort (z=-1.137, p=0.25). There were 4EM-related operating room delays with an average case delay of 31.5min (5-60min). Twenty-four (24%) EM patients/families required secondary phone calls, while 106 (50%) NPC required a follow up phone call (p<0.01). 94% of EM participants recommended EM for future perioperative instructions. Accounting for the average case volume within our entire children's hospital, the average total daily cost for EM is $5.96/day, as compared to an average total cost of $87.78/day to perform NPC. This represents an estimated cost savings of $81.82 per day or $21,273.20 per year, based upon average total case volume at our institution. In our initial experience, EM effectively communicates the necessary preoperative information to patients and/or families undergoing pediatric urology surgery. Our results demonstrate low case cancellation and delay rates and high patient/family satisfaction. Also demonstrated was the cost savings by replacing the NPC with EM. A great benefit of EM was the increased time it provided for nurses to perform other patient care duties, which is important given our current nationwide nursing shortage. Limitations of the study included a narrow scope assessing only pediatric urology patients as well as a short study period. Further studies will further define and refine the role of perioperative EM. Changing to an EM system for preoperative instructions in the pediatric urology population met with a high degree of patient satisfaction and decreased costs for healthcare systems without increasing case delay or cancellation rates.

Prehabilitation as an important stage before cardiac surgery

The review discusses the preparation of patients for surgery on the heart and other organs. We considered the importance of introducing a new stage of medical and cardiology rehabilitation — prehabilitation. The results of randomized clinical trials, systematic reviews and metaanalyzes evaluating the effectiveness of respiratory techniques and physical training during the prehabilitation are presented. Particular attention is paid to the involvement of patients in prehabilitation programs before the elective coronary artery bypass grafting. Methodological problems arising in the development of prehabilitation programs are discussed.

Fast track for partial nephrectomy

The study objective: estimation of two group patients, treated in N.N. Petrov National Medical Research Center of Oncology with renal cell carcinoma.Materials and methods. The 1st group include patients with standard postsurgical care management after open renal resection with lumbotomy access and warm renal ischemia. The 2nd group include the same treated patients with minimally invasive surgeries and fast track elements under induced hypotension. We analysed preparation of patient for surgery, differences in after treatment care management, frequencies and pain severity, after treatment complications, blood loss severity.Results and conclusion. Research suggests that the system of enhanced recovery after renal resection ensure early patients rehabilitation with two-time less hospitalization period.

On the use of aqueous solutions of polyvinyl methyl ether for the embolization of blood vessels

Aqueous solutions of polyvinyl methyl ether were investigated in order to test whether it is possible to utilize them as bases for embolic agents used to deliberately block blood vessels. This may be necessary in the course of treatment of vascular abnormalities, tumors, as well as during the preparation of patients for surgery. The right branch of the binodal curve for the binary system “polyvinyl methyl ether–water” was drawn using the cloud point method and the lower critical mixing temperature (35.5 °C) was calculated. Furthermore, the exact concentration of polyvinyl methyl ether in aqueous solutions at which phase transition occurs (given the temperature of 35.5 °C) was found to be 30 wt %. The viscosity–velocity curves for the 30% solution of polyvinyl methyl ether, obtained by rheoviscometry in the temperature range of 5 to 36 °C, indicate that this aqueous solution has a low viscosity and behaves like a Newtonian fluid. However, at the temperature of 35 °C and higher, close to the phase transition, a significant deviation from its Newtonian behavior is observed due to precipitation of polyvinyl methyl ether as it forms a solid white mass. Through the use of the Arrhenius–Frenkel–Eyring equation, the activation energy of the viscous flow for polyvinyl methyl ether solutions was found to be 31 kJ/mol. Based on refractometry data, it was demonstrated that phase transition in aqueous solutions of polyvinyl methyl ether is reversible. This feature can facilitate medical equipment cleaning before introducing the embolic agent into a patient’s bloodstream. Finally, the investigation determined some parameters, in which the formation of embolic agents from a 30% polyvinyl methyl ether aqueous solution occurs (in situ in a blood vessel at a temperature of 35.5 °C).

Release of sodium pyruvate from sacral prophylactic dressings: A computational model.

The use of sacral dressings for pressure ulcer prevention is growing rapidly. In addition to their passive biomechanical role in pressure and shear reduction, in the near future, prophylactic dressings may also provide active tissue protection by releasing preventive agents or drugs into skin and deeper tissues. We investigated delivery of sodium pyruvate (NaPy) from an active dressing to potentially protect the sacral skin and underlying tissues in addition. We used four finite element model variants describing different skin roughness levels to determine time profiles of NaPy diffusion from the dressing into the skin layers. The NaPy concentrations for the different modelled cases stabilised after 1 to 6.5 hours from the time of application of the dressings, at 1% to 3% of the NaPy concentration in the dressing reservoir, which is considered potent. We conclude that prophylactic sacral dressings have the potential to deliver NaPy into skin and subdermally, to potentially increase soft tissue tolerance to sustained bodyweight-caused cell and tissue deformations. The time durations to achieve the steady-state potent NaPy dermal concentrations are clinically feasible, for example, for preparation of patients for surgery or for use in intensive care units.

Bariatric Surgery in Children: Indications, Types, and Outcomes.

The purpose of this review is to discuss the current state of surgical intervention for obesity in children and adolescents. Specifically, this review will discuss the different types of metabolic and bariatric surgery (MBS) procedures, guidelines for patient selection, and recent findings regarding surgical outcomes and complications. MBS is safe in adolescents and has also demonstrated sustainable long term weight loss and improvement in obesity-associated comorbidities. A recent prospective multi-institutional trial demonstrated BMI reductions of 3.8kg/m2 (8%) to 15.1kg/m2 (28%) after 3years among adolescents undergoing the three most common MBS procedures. Moreover, MBS is associated with remission of type 2 diabetes, prediabetes, hypertension, dyslipidemia, and abnormal kidney function in 65-95% of patients in the study. Childhood and adolescent obesity is a continuing problem that has not been adequately addressed by the medical community. MBS is currently the most successful strategy for significant and sustained weight loss and improvement of associated comorbidities. This review focuses on the different types of MBS, the selection and preparation of patients for surgery, and the expected outcomes and common complications.

Clinical Updates in Women's Health Care Summary: Surgical Considerations: Primary and Preventive Care Review.

Obstetrician-gynecologists often incorporate surgical procedures in the care of women. Each phase of a woman's life cycle presents different challenges regarding preoperative, intraoperative, and postoperative management. Appropriate workup and preparation of patients for surgery are key to a successful surgical outcome. As women age, their risk of medical comorbidities, such as coronary artery disease, diabetes mellitus, or obesity, increases, as does the need for surgical procedures. Correctly identifying medical conditions and related surgical risks will help obstetrician-gynecologists provide safe, appropriate, and evidence-based care to women. Increasingly, obstetrician-gynecologists work in the setting of multidisciplinary teams, and many have access to preoperative assessment clinics and hospitalists to assist in the management of preoperative and perioperative patients. It is the responsibility of the referring physician to understand the services these clinics and hospitalists provide. An appropriate and cost-effective evidence-based preliminary workup, such as laboratory and imaging tests, also is important. The purpose of this monograph is to help guide obstetrician-gynecologists through the appropriate preoperative assessment of women who require surgery and identify intraoperative and postoperative management strategies that will help decrease avoidable morbidity and mortality of these patients.

Overview on Miss Management in Turn over Time in Orthopaedic Operative Room

Background: The operating room (OR) is one of the most important hospital units, but wasted time negatively affects its efficiency. The need to provide timely patient care has prompted this assessment of the time is required to transfer patients to the OR. Patients and Methods: This study examined 382 patients undergoing orthopedic surgery in our orthopedic ward. Patient demographic information, mode of transfer, anesthesia type and surgery site were recorded. The time elapsed during the transfer of patients between stages was measured. Results: Time from the surgical team informing the OR staff about impending surgery and the orthopaedic ward being told to transfer the patient was 3.091±2.804 min. Furthermore, the time spent transferring patients from the orthopaedic ward to the OR was 27.622±17.198 min. The time of preparing the OR, administering anesthesia, patient preparation for surgery, surgical procedure, and transferring to the recovery room were 18.287±16.835 min, 23.785±32.498 min, 48.324±37.9 min, 85.790±61.859 min and 13.738±9.088 min, respectively. The patients spent 32.617±15.88 min in recovery room before transfer back to the ward. The type of anesthesia or surgery site was found not to be associated with the time elapsed at each stage. There was no significant relationship between the time required to transfer patients from the orthopaedic ward to the OR and the mode of transfer (gurney or wheelchair). Conclusions: The presence of trained staff for the proper turn-over of patients in the a department and in the OR, their cooperation, teamwork, interaction and careful monitoring of the staff in the OR and specialized training for the staff can decrease problems in this area.

Atuação da enfermagem em cirurgia cardíaca minimamente invasiva videoassistida*

Objetivo: Relatar a atuação da enfermagem no perioperatório da cirurgia cardíaca minimamente invasiva videoassistida. Método: Trata-se deum relato de experiência da equipe de enfermagem no perioperatório dessa técnica cirúrgica, realizada em um hospital-escola que é referência em cardiologiano Estado de São Paulo. Resultados: Observa-se a importância da atuação da enfermagem no preparo do centro cirúrgico (CC), recepção dopaciente, assistência ao ato anestésico, preparo do paciente para a cirurgia, atendimento à equipe no período intraoperatório e na saída do paciente desala operatória (SO), atendendo às demandas desta modalidade cirúrgica inovadora. Conclusão: A enfermagem de centro cirúrgico (CC) deve ser capacitadaa acompanhar a evolução das técnicas cirúrgicas, tanto no manuseio dos novos materiais e equipamentos como na assistência direta ao paciente,visando à segurança cirúrgica.

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB).

The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.

A patient-centered surgical home to improve outpatient surgical processes of care and outcomes

Preparing patients for surgery is critical for achieving the best possible surgical outcomes. To do this effectively, care must be coordinated across several types of specialists, and potentially across multiple settings. In this paper, we develop a Patient-Centered Surgical Home (PCSH) for outpatient surgery based on the concept of the Perioperative Surgical Home proposed by the American Society of Anesthesiologists. A key feature of the PCSH is to have an anesthesiology preoperative assessment clinic (APC) serve as system coordinator and information integrator. Based on a study of outpatient surgery at the University of Texas Health Science Center at San Antonio and its primary teaching hospital using statistical analysis and simulation, we demonstrate how this can be accomplished. We show that for the PCSH to succeed, APC must see the right patients with the right information by overcoming improper triaging of patients and patient information deficiencies. Our analysis shows that with the proper screening tool and modifications to the way triage is handled, it is possible to increase the number of patients that the APC sees each day with a modest increase in resources. Much of the potential benefits rest on the cooperation of the referring clinics as well as closing the gap between the current level of patient information and what is needed for optimizing medical decisions. Estimated cost savings are over one million dollars annually with a PCSH. Since APC-like clinics are common, our findings have great potential for widespread implementation of similar PCSH models with commensurate benefits.

Study of Surgical Site Infections following Gynaecological Surgery at tertiary care teaching hospital in Rural India

Objectives: To find out the incidence, risk factors and microorganisms responsible for of surgical site infections. Material and Methods: The prospective observational study was carried out in the tertiary care teaching hospital over a period of two years Consecutive 100 cases of surgical site infections(SSI) following obstetric and gynecological abdominal surgery were analyzed using Statistical Package of Social Sciences version -16.0 Results: The incidence of surgical site infections was 2.8 percent among 3498 surgeries performed during study period. Overweight, previous laparotomy scars, emergency surgery and caesarean section following prolong labour were the common risk factors associated with the development of SSI. Suboptimum peri-operative conditions related to preparation of patient for surgery, below ideal operation theatre conditions, humidity, long list of operations, practice of shaving of part day prior, water scarcity in summer and casual approach by health professionals while surgical scrubbing and donning and uncontrolled movement of patients relatives in the postoperative ward predisposed patients for development of SSI. Staphylococcus aureus and gram negative bacilli like E.Coli and pseudomonas were mainly isolated from the wound specimens. Conclusion: Surgical site infections can be prevented by proper pre-operative assessment of cases, strict compliance with scrubbing and donning protocols, skillful surgery, avoiding overcrowding in operation theatre and post operative wards and by maintaining conducive theatre environment.

Diagnostic, therapeutic and healthcare management protocols in parathyroid surgery: II Consensus Conference of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

To update the Diagnostic-Therapeutic-Healthcare Protocol (Protocollo Diagnostico-Terapeutico-Assistenziale, PDTA) created by the U.E.C. CLUB (Association of the Italian Endocrine Surgery Units) during the I Consensus Conference in 2008. In the preliminary phase, the II Consensus involved a selected group of experts; the elaboration phase was conducted via e-mail among all members; the conclusion phase took place during the X National Congress of the U.E.C. CLUB. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. The PDTA for parathyroid surgery approved by the II Consensus Conference (June 2013) is the official PDTA of the U.E.C. CLUB.