Quality Of Recovery Research Articles

Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial

BackgroundEnhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and...

Клінічні результати використання протоколу прискореного відновлення дітей після корекції лійкоподібної деформації грудної клітки

The funnel-shaped deformity of the chest is the most common defect of the chest, which can cause cosmetic problems, but also a decrease in tolerance to physical activity, cause fatigue, shortness of breath and chest pain. The application of the enhanced recovery protocol and rehabilitation interventions after Nuss procedure are poorly described in the literature. Purpose - to evaluate the clinical results of using a modified protocol of enhanced recovery after surgical correction of pectus excavatum in children. Materials and methods. The results of the treatment of 79 patients with a funnel-shaped chest deformity aged (14.2±1.6) who underwent surgical correction of the deformity according to Nuss method were analyzed. Two groups of patients were analyzed, according to the protocol of postoperative management: the Group I (n=20) - patients of traditional postoperative management, the Group II (n=59) - according to the the enhanced protocol of recovery. In the Group II, psychological and physical training was additionally included in the preoperative plan. Results. The groups were the same in terms of age, Haller index, and time of surgery (p>0.05). The length of stay in the hospital was significantly (p<0.001) shorter in patients of the Group II. The use of the epidural analgesia method in patients of the Group II made it possible to significantly reduce both the dose and the duration of taking opioid analgesics to 1 day, in contrast to the Group I (up to 3 days). The lack of pleural drainage enabled the patient to become more active after a day - to get up, walk, and take some procedures. Conclusions. The protocol of the enhanced postoperative recovery, which includes a program of rehabilitation treatment, early removal of the urinary catheter and early verticalization of the patient, improves the quality of recovery of patients after reconstruction of funnel-shaped deformity of the chest and reduces the length of stay of patients in hospital treatment after surgery. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial

Background and objectivesPerioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could...

Neuropathic pain development and maintenance and its association with motor recovery after cervical spinal cord injury

Background In our published randomized controlled trial, we revealed that patients with acute ASIA Grade C incomplete cervical spinal cord injury (SCI) who underwent early surgery (within 24 h post-injury) had accelerated motor recovery at six months than those with delayed surgery (>2 weeks post-injury); however, neuropathic pain (NeP) worsened regardless of surgery timing. Here, we conducted post-hoc analyses to intensively assess NeP development and maintenance. Methods Of 44 patients (median 64.5 years; three female; early intervention, n = 26), NeP was categorized into at-level and below-level pain and evaluated at two weeks and one year after injury using the Neuropathic Pain Symptom Inventory (NPSI). We compared the two groups based on background characteristics. A mixed-design analysis of variance with sex as a covariate was conducted to analyze motor recovery and Health-related quality of life (HRQOL) in groups with severe (NPSI ≥ 10) or mild (NPSI < 10) pain. Results Upper and lower limb motor impairments were comparable between both groups regardless of pain severity. Severe at-level pain remained stable and worsened at one year than mild at-level pain; however, the upper- and lower-limb motor scores and HRQOL had comparable recovery. Background characteristics did not affect severity or time course of NeP. Patients with severe below-level pain demonstrated slower lower-limb motor recovery than those with mild below-level pain, whereas HRQOL improved regardless of pain severity. Conclusions Both at-level and below-level NeP developed and persisted relatively early in the course of traumatic SCI with incomplete motor paralysis; their severities worsened over time or remained severe since onset.

Effect of ultrasound-guided bilateral superficial cervical plexus block versus perioperative intravenous lidocaine infusion on postoperative quality of recovery in patients undergoing thyroidectomy: A randomised double-blind comparative trial.

Recent studies have found that ultrasound-guided (USG) bilateral superficial cervical plexus block (BSCPB) and intravenous infusion of lidocaine (IVL) have the potential to improve the quality of postoperative recovery. This study aimed to investigate and compare their effects on postoperative quality of recovery in patients undergoing thyroidectomy. A total of 135 patients were randomised to Group N: BSCPB with 10 mL 0.75% ropivacaine on each side, Group L: intravenous lidocaine (1.5 mg/kg for 10 min, followed by 1.5 mg/kg/h) and Group C: intravenous saline combined with BSCPB saline. The primary objective was quality of recovery-40 (QoR-40). Other parameters compared were numeric rating pain scale (NRS) score, haemodynamic data, opioid dosage and incidence of adverse effects. Statistical analysis was performed using the one-way analysis of variance (ANOVA), the Kruskal-Wallis test and the Chi-square test. Compared to Group C, both groups N and L had higher QoR-40 total scores as well as scores indicating physical comfort, emotional state and pain dimensions on postoperative day (POD) 1 and POD2 (P < 0.001). The QoR-40 total and pain dimension scores in Group N were higher on POD1 and POD2 (P < 0.05). The NRS scores and the change in haemodynamics were lower in Group N compared to groups L and C (P < 0.05). The results of other parameters were lower in groups N and L than in Group C (P < 0.05). USG BSCPB and IVL are comparable in improving the quality of postoperative recovery in patients undergoing thyroidectomy.

A Countertraction Closed Reduction Technique in Minimally Invasive Fixation of Recent Type C Pelvic Ring Injuries.

Closed reduction of pelvic injuries is a prerequisite and critical step in minimally invasive treatment. Achieving non-invasive closed reduction of pelvic injuries is a challenging clinical problem. This study demonstrated a non-invasive traction technique for closed reduction called countertraction closed reduction technique (CCRT) and evaluated its effectiveness for type C pelvic ring injuries. The data of patients with unstable pelvic fractures treated with CCRT and minimally invasive fixation were retrospectively reviewed from January 2017 to February 2022. Sacroiliac screws were placed to fix the posterior pelvic ring, and internal or external fixation was used to fix the anterior pelvic ring. Operation time, intraoperative blood loss, duration of hospital stay, fracture union and postoperative complications were recorded. Fracture reduction quality was evaluated using the Matta scoring criteria. Functional recovery and general quality of life were evaluated using the Majeed functional scoring criteria. Thirteen patients (nine males and four females), with an average age of 49.6 years were treated with CCRT and followed up for a mean of 18.5 months. The average operation time was 137.2 minutes (range 92-195 minutes), the average intraoperative blood loss was 31.2 mL (range 10-120 mL) and the average duration of hospital stay was 14.3 days (range 4-32 days). All patients achieved bony union with an average union time of 11.9 weeks (range 10-16 weeks). According to the Matta radiographic criteria, the quality of fracture reduction was excellent in eight patients, good in four, and fair in one. The average Majeed functional score was 89.7 (range 78-100). The functional evaluation revealed that the outcomes were excellent in nine patients, and good in four patients. Complications included incision fat liquefaction in one patient, and heterotopic ossification in another patient. There were no surgical complications as a result of CCRT. CCRT is a non-invasive closed reduction method for minimally invasive fixation of fresh Tile C1 and C2 pelvic fractures. The advantages of CCRT combined with minimally invasive treatment include a small surgical incision, reduced intraoperative bleeding, satisfactory fracture reduction, bone healing and functional recovery.

Comparative evaluation of continuous infusion versus programmed intermittent bolus techniques in erector spinae plane block in modified radical mastectomy - A preliminary randomised controlled trial.

Single-shot erector spinae plane block (ESPB) provides excellent analgesia in mastectomy in the immediate post-operative period but is not sufficient to maintain for prolonged duration. This study compares the efficacy of programmed intermittent bolus (PIB) versus continuous infusion (CI) techniques after ESPB by placing a catheter for mastectomy. After ethical approval and patient consent, ESPB was performed at the T4 level in 50 patients with an initial bolus of 20 mL 0.375% ropivacaine and a catheter placed 30 min before surgery. In the postoperative period, they were randomised to Group I - intermittent bolus of 20 mL 0.2% ropivacaine every 4 h for 24 h and Group C - continuous infusion of 0.2% ropivacaine at 5 mL/h for 24 h. The primary outcome was the 24-h fentanyl consumption by patient-controlled analgesia device. Data was analysed using Stata 14.0. Group I patients had reduced post-operative fentanyl consumption {mean [standard deviation (SD)]: 166 (139.17) µg vs 332 (247.96) µg, P = 0.002} and lower median NRS scores (1 h: 3 vs 5), (2 h: 3 vs 5), (4 h: 3 vs 5), (6 h: 4 vs 5) with a higher mean (SD) Quality of Recovery-15 score {134.4 (8.53) vs 127 (12.89), P = 0.020} compared to Group C, respectively. The 24-h dermatomal sensory coverage was more comprehensive in Group I compared to Group C. The PIB technique after ESPB provides decreased postoperative opioid consumption, better post-operative analgesia and quality of recovery compared to the CI technique in patients undergoing mastectomy.

Quality of Recovery After Unplanned and Planned Cesarean Deliveries: A Prospective Observational Study Using the Obstetric Quality of Recovery-10 Tool.

There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries. We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings. We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients' perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries). As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.

Investigating the level of medication adherence and subjective recovery in patients diagnosed with schizophrenia

Background &amp; Aim: Low compliance with medication in patients with schizophrenia may negatively affect the quality of life and subjective recovery. The objective was to analyze the association between medical adherence and subjective recovery in individuals diagnosed with schizophrenia.&#x0D; Methods &amp; Materials: This descriptive and correlational research was conducted between July and August 2023. 120 patients registered with a Schizophrenia Relatives Association in Türkiye were included in the study using simple random sampling. Demographic questionnaire, Medication Adherence Report Scale, and Subjective Recovery Assessment Scale were used in the study. Percentage, mean, t-test in independent groups, one-way ANOVA, and Pearson correlation coefficient were used to data analysis in SPSS 25.&#x0D; Results: Medication Adherence and Subjective Recovery mean scores were 22.85±3.57 and 61.82±15.37 respectively. It was revealed that there is a positive and statistically significant relationship between Medication Adherence and Subjective Recovery scores (r=0.269, p&lt;0.01). As well as between age and Medication Adherence Report Scale (r=0.215, p&lt;0.05). The subjective recovery level was significantly lower in smokers compared to non-smokers (p&lt;0.05).&#x0D; Conclusion: Subjective recovery levels of psychiatric patients can be increased by monitoring their medication adherence levels. Supportive interventions (giving motivational talks for medication use, following up with patients by phone or home visit, etc.) should be implemented for those who do not adhere to their medication regimen.

Trajectories of Recovery Following Traumatic Brain Injury Among Older Medicare Beneficiaries.

It is well-known that older adults have poorer recovery following traumatic brain injury (TBI) relative to younger adults with similar injury severity. However, most older adults do recover well from TBI. Identifying those at increased risk of poor recovery could inform appropriate management pathways, facilitate discussions about palliative care or unmet needs, and permit targeted intervention to optimize quality of life or recovery. We sought to explore heterogeneity in recovery from TBI among older adults as measured by home time per month, a patient-centered metric defined as time spent at home and not in a hospital, urgent care, or other facility. Using data obtained from Medicare administrative claims data for years 2010-2018, group-based trajectory modeling was employed to identify unique trajectories of recovery among a sample of United States adults age 65 and older who were hospitalized with TBI. We next determined which patient-level characteristics discriminated poor from favorable recovery using logistic regression. Among 20,350 beneficiaries, four unique trajectories were identified: poor recovery (n = 1929; 9.5%), improving recovery (n = 2,793; 13.7%), good recovery (n = 13,512; 66.4%), and declining recovery (n = 2116; 10.4%). The strongest predictors of membership in the poor relative to the good recovery trajectory group were diagnosis of Alzheimer's disease and related dementias (ADRD; odd ratio [OR] 2.42; 95% confidence interval [CI] 2.16, 2.72) and dual eligibility for Medicaid, a proxy for economic vulnerability (OR 5.13; 95% CI 4.59, 5.74). TBI severity was not associated with recovery trajectories. In conclusion, this study identified four unique trajectories of recovery over one year following TBI among older adults. Two-thirds of older adults hospitalized with TBI returned to the community and stayed there. Recovery of monthly home time was complete for most by 3 months post injury. An important sub-group comprising 10% of patients who did not return home was characterized primarily by eligibility for Medicaid and diagnosis of ADRD. Future studies should seek to further characterize and investigate identified recovery groups to inform management and development of interventions to improve recovery.

Acute COVID-19 treatment is not associated with health problems 2 years after hospitalization

ObjectivesVarious mechanisms, such as immune dysregulation, viral reservoir, and auto-immunity, are hypothesized to underlie the pathogenesis of long-term health problems after hospitalization for COVID-19. We aimed to assess the effect of in-hospital COVID-19 treatments on prominent long-term health problems. MethodsIn this prospective multicenter cohort study, we enrolled patients (age ≥18 years) who had been hospitalized for COVID-19 in the Netherlands between July 2020 and October 2021. We retrospectively collected data on in-hospital COVID-19 treatments, including steroid, anti-inflammatory, and antiviral treatments. Patients completed questionnaires on self-reported recovery, dyspnea, fatigue, cognitive failures, and health-related quality of life and performed the 6-minute walk test at the 2-year follow-up visit. ResultsFive hundred two patients with COVID-19 were included, all were discharged from the hospital between March 2020 and June 2021. The median age at admission was 60.0 (IQR 53.0-68.0) years and 350 (69.7%) patients were male. At hospital admission, 5/405 (1.2%) of the patients had been vaccinated against SARS-CoV-2. Among all 502 patients, the majority (248 [49.4%]) received steroids only, 57 (11.4%) anti-inflammatory treatment, 78 (15.5%) antiviral treatment, and 119 (23.7%) none during hospitalization. Long-term health problems were common in all groups. We found that in-hospital treatments were not significantly associated with health problems at 2 years after hospital discharge, nor after adjusting for confounders. ConclusionMany patients with COVID-19 suffer from long-term health problems 2 years after hospital discharge. Acute treatment for COVID-19 is not associated with long-term health problems.

Predictive insights for copper recovery: A synergistic approach integrating variability data and machine learning in the geometallurgical study of the Tizert deposit, Morocco

This work involved the application of machine learning (ML) to predict copper recovery through variability data in the context of the geometallurgical study of the Tizert deposit in Morocco. For this purpose, geological and metallurgical variability investigations were conducted on drilling samples from Tizert ore, leading to the consolidation of a robust database for ML algorithms. The dataset comprised 345 observations across seven variables, namely GPS coordinates, geological units, lithological facies, the main copper deportment, and metallurgical responses from flotation tests, as well as the copper grade and the oxidation rate. The geological and mineralogical variability revealed two geological units: The Basal Series and Tamjout Dolomite unit, hosting copper mineralization dominated by chalcocite and malachite. Besides, the metallurgical evaluation demonstrated recovery variability, primarily influenced by oxidized copper. Copper oxides exhibit less efficient flotation than sulfides, with recovery decreasing as the oxidation rate increases. The prediction of copper recovery was performed using the variability data through the XGBoost algorithm. The resulting model showed good performance on the test dataset, with a coefficient of determination R2 of 0.83 and a RMSE of 2.47, improving the accuracy of copper recovery predictions. In addition, the model elucidated the most significant variables impacting Tizert ore behavior, notably the casing, copper-bearing mineral, and oxidation rate. These variables were considered key factors for advancing Tizert ore valuation and geometallurgical model development. Overall, metallurgical modeling based on the ML approach provided an innovative way to integrate variables into mine planning and processing. The use of such a predictive model gave valuable insights for improving efficiency, understanding the metallurgical behavior, optimizing production, and reducing costs along the value chain of the Tizert deposit. Further data processing efforts are underway, to improve the assessment of copper recovery quality for the Tizert ore and the development of a complete geometallurgical model on a plant scale.

Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial

Introduction Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection. Patients and Methods We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg−1 bolus over 10 min, followed by continuous infusion at 2 mg kg−1 h−1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events. Results Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1–6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11). Conclusions In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical ). Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.

Effects of intravenous xylazine versus dexmedetomidine premedication with ketamine-midazolam-isoflurane anaesthesia for castration in horses

The objectives of this research was to study the sedation and anaesthetic characteristics of intravenous xylazine and dexmedetomidine combined with ketamine-midazolam-isoflurane and to evaluate the cardiopulmonary effects during the anaesthetic period. Stallions were premedicated with xylazine (1.1 mg/kg IV) in Group 1 and dexmedetomidine (3.5 µg/kg IV) in Group 2. Sedation quality was evaluated and scored. General anaesthesia was achieved with ketamine (2.2 mg/kg IV) and midazolam (0.1 mg/kg IV) in both groups and anaesthesia was maintained with isoflurane inhalant in fresh oxygen gas flow (6-8 L/min). All the stallions underwent an orchiectomy by the half- closed method. Cardiovascular variables and pulmonary variables were recorded using multi gas vital sign monitor. Anaesthetic parameters, reflex status and quality of muscle relaxation were assessed. After the surgical procedure, recovery was monitored and scored on 6 point scale. Sedation score and quality was clinically better in Group 2. The difference in cardiopulmonary variables was statistically not significant. However, statistically significant changes were noticed between two groups with regard to some blood gas values during the intra-operative and at 15 min post anaesthetic period. Quality of muscle relaxation was better in group 2. Recovery was not significant. Overall quality of anaesthesia and recovery was almost similar in both the groups. In conclusion, both drug combinations produced satisfactory results for castration in the horses studied. In this study, dexmedetomidine at 3.5 µg/kg and xylazine at 1.1 mg/kg sedative doses did not result in much significant changes compared to one other.

A Comparative Study of Postoperative Analgesic Efficacy of Suprainguinal versus Infrainguinal Approach of Ultrasound-guided Fascia Iliaca Compartment Block using 0.2% Ropivacaine in Patients Undergoing Surgery for Hip Fracture under Spinal Anesthesia

Abstract Context: Fascia iliaca compartment block (FICB) is a useful modality to provide postoperative analgesia in patients with hip fracture undergoing surgery. Aims: The aims of this study were to compare the analgesic efficacy of suprainguinal versus infrainguinal approach of ultrasound-guided FICB using 0.2% ropivacaine in patients undergoing surgery for hip fracture under spinal anesthesia. Settings and Design: It was a prospective, randomized, controlled study. Subject and Methods: Group A (n = 25) received ultrasound-guided FICB by suprainguinal approach and Group B (n = 25) received ultrasound-guided FICB by infrainguinal approach. The primary objective was to compare 24-h postoperative analgesic efficacy using Numeric Rating Scale (NRS) score. Statistical Analysis: For data analysis, t-test, Mann–Whitney test, and Chi-square test were applied. Results: NRS score after 30 min of FICB in Group A was 2.36 ± 1.11 which was lower in comparison to 3.28 ± 0.94 in Group B (P = 0.002). NRS score during positioning in Group A was 2.16 ± 0.90, which was lower than Group B 3.08 ± 0.81 (P = 0. 0004). Greater block coverage was achieved in obturator nerve distribution in Group A 0.76 ± 0.52 compared to 0.16 ± 0.37 in Group B (P &lt; 0.001). The total duration of analgesia was 493.40 ± 214.83 min, which was more in Group A than in Group B 367.48 ± 63.92 min (P = 0.007). Quality of recovery (QoR) score out of 150 in Group A was 120.60 ± 8.91 compared to 110.40 ± 7.59 in Group B (P &lt; 0.001). Conclusion: FICB by suprainguinal approach provides better analgesia, sensory block coverage, and conditions for positioning for spinal anesthesia and also has a higher time to first rescue analgesic requirement with better QoR compared to infrainguinal approach.

Postoperative Complications and Mobilization Following Major Abdominal Surgery With Versus Without Fitness Tracker-based Feedback (EXPELLIARMUS): A Student-led Multicenter Randomized Controlled Clinical Trial of the CHIR-Net SIGMA Study Group.

To determine whether daily postoperative step goals and feedback through a fitness tracker (FT) reduce the rate of postoperative complications after surgery. Early and enhanced postoperative mobilization has been advocated to reduce postoperative complications, but it is unknown whether FT alone can reduce morbidity. EXPELLIARMUS was performed at 11 University Hospitals across Germany by the student-led clinical trial network SIGMA. Patients undergoing major abdominal surgery were enrolled, equipped with an FT, and randomly assigned to the experimental (visible screen) or control intervention (blackened screen). The experimental group received daily step goals and feedback through the FT. The primary end point was postoperative morbidity within 30 days using the Comprehensive Complication Index (CCI). All trial visits were performed by medical students in the hospital with the opportunity to consult a surgeon-facilitator who also obtained informed consent. After discharge, medical students performed the 30-day postoperative visit through telephone and electronic questionnaires. A total of 347 patients were enrolled. Baseline characteristics were comparable between the 2 groups. The mean age of patients was 58 years, and 71% underwent surgery for malignant disease, with the most frequent indications being pancreatic, colorectal, and hepatobiliary malignancies. Roughly one-third of patients underwent laparoscopic surgery. No imputation for the primary end point was necessary as data completeness was 100%. There was no significant difference in the CCI between the 2 groups in the intention-to-treat analysis (mean±SD CCI experimental group: 23±24 vs. control: 22±22; 95% CI: -6.1, 3.7; P=0.628). All secondary outcomes, including quality of recovery, 6-minute walking test, length of hospital stay, and step count until postoperative day 7 were comparable between the 2 groups. Daily step goals combined with FT-based feedback had no effect on postoperative morbidity. The EXPELLIARMUS shows that medical students can successfully conduct randomized controlled trials in surgery.

The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial.

No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85-0.92) and 0.73 (0.64-0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability.

Recycling Potential of Construction Materials: A Comparative Approach

Recovery and re-utilization of materials are regarded as key strategies for reducing greenhouse gas emissions in the built environment. Within those end-of-use scenarios, recycling is one of the widely used tactics, demonstrated by established infrastructure and developed supply chain networks in many geographic locations. While recycling is an increasingly common practice in the built environment, accurately defining recycling quality in order to compare technologies and material types remains methodologically contested. This is mainly due to the vast spectrum of scenarios that typically fall under the term ‘recycling’. Remanufacturing, downcycling, upcycling, and even direct reuse are all referred to as types of recycling in non-scientific circles, depending on the sector they occur in. The main challenge in assessing the material recovery quality of those solutions is that they exist on a continuum without clear divisions. Within that context, this article presents and compares four methods for assessing recyclability. The featured methods measure recycling potential from different perspectives: economic dimensions of the recycling industry; patterns of resource depletion; the energy cost of recycling; and the carbon intensity of recovery processes. The scientific foundations of the four methods are presented and a range of widely used construction materials are tested. The performance of materials is then compared across the four assessment methods to note observations and gain insights. Some of the materials are found to consistently outperform others, whereas some materials perform well on one method while performing poorly on others. This comparative study is followed by a discussion that looks at the limitations of each approach and reasons, or lack thereof, for the adoption of one method over the others in industry and academia. Lastly, the article looks at future research trajectories and examines the path ahead for recycling in the construction industry.

Assessing the Quality of Postoperative Recovery: A Guide for Making Adjustments in Anesthesia Delivery

PurposeThe purpose of this project was to develop a plan and then implement a process for improving anesthesia delivery at a surgery center in the Southeast United States over a 2-month period. DesignThe design of the project was based on utilization of the instrument QoR-15 (Quality of recovery - 15 item questionnaire). This tool is a valid and reliable instrument for the measurement of postoperative outcomes. The QoR-15 includes 15 questions that can each be scored on a 10-point scale. MethodsMethods included a literature search, collecting pre-assessment data, making phone calls to patients utilizing QoR-15 tool, analyzing data, presenting findings to stakeholders, creating a plan of future anesthesia care adjustments. FindingsThe results revealed the following outcome data: a total of 183 postoperative phone calls were successfully performed. The calls were completed on the first postoperative day during the months of July and August 2021. There were 459 total cases during this 2-month period with 113 successful patient contacts (24.6 % successful contact rate). Mean scores of the QoR-15 data for the total population were above 9 for all 15 items. The data was then analyzed according to surgical specialty. The category of moderate pain scores in patients from the General and Ophthalmology surgical specialties were 7.9 and 7.8 respectively. General surgery patients also had one of the highest scores in severe pain with a mean of 8.7. ConclusionsIn conclusion, the leadership team at the ASC received a formal presentation of the results and recommendations for future adjustments that could be potentially implemented in anesthesia care. The benefits of regional anesthesia were suggested to help achieve better patient pain outcomes in both the General and Ophthalmologic surgical populations.

Effectiveness of ultrasound-guided rhomboid intercostal and sub-serratus block for perioperative analgesia in male patients undergoing combined power-assisted liposuction with pull-through excision of the gland for breast definition and reshaping.

The newly introduced ultrasound guided interfacial rhomboid intercostal and sub-serratus (RISS) block technique demonstrated promising efficacy in managing perioperative pain among patients undergoing abdominal and thoracic procedures. Thus, this study investigated the efficiency of bilateral ultrasound-guided RISS (US-RISS) as a perioperative pain control technique in male subjects receiving gynecomastia surgery. This prospective randomized study involved sixty patients who underwent gynecomastia surgery. Individuals were randomly divided into two groups: the RISS group (N.=30) and the control group (N.=30). After anesthesia induction, the patients received bilateral US-RISS using 40 mL of 0.25% levobupivacaine, or conventional intravenous analgesia with no intervention, respectively. The primary outcome was the overall morphine consumption in 24 hours, and the secondary endpoints involved the time elapsed till rescue analgesia was requested, the quality of recovery after 24 hours and side effects' incidence. Morphine consumption was noticeably decreased in the RISS group compared to the control group, with 14.07±4.91 mg and 35.83±1.70 mg mean values, respectively (P<0.001). Furthermore, in the RISS group, the initial rescue analgesia request occurred significantly later than in the control group, with mean values of 15.58±1.41 hours and 0.96±0.63 hours, respectively (P<0.001). Additionally, within the RISS group, there was a high quality of recovery observed, with a low incidence of opioid-related adverse events in comparison to the control group. Bilateral US-RISS block is a beneficial intervention in gynecomastia surgery for pain management and improves the quality of recovery.