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This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients’ path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.

Aim:There is a need to assess the pain fear levels of surgical patients simply and appropriately before the surgery. This study aimed to develop and test the psychometrics of an instrument to evaluate the fear of postoperative pain.Methods:This methodological study was conducted at four surgical clinics including general surgery, orthopedics and traumatology, neurosurgery, heart and vessel surgery of a university hospital between 28 March and 19 October 2018. Totally, 150 patients who were scheduled for elective surgery and at their preoperative day were included. This scale contained 10 items related to the postoperative pain sources and aimed to identify the pain fear of patients preoperatively. To measure the sampling adequacy, Kaiser-Meyer-Olkin index and Bartlett’s test of sphericity was used. Explanatory and confirmatory factor analyses were conducted to evaluate the construct validity. The internal consistency of the scale was evaluated by Cronbach’s alpha calculation. All hypotheses were tested in two directions.Results:The total variance explained 55.5% of the variance for one factor structure consisting of 10 items. The model fit index values through the confirmatory factor analysis were found to support this structure.Conclusion:The scale is appropriate to be used in clinical settings to quickly evaluate the elective surgical patients’ fear level of postoperative pain preoperatively.

This is the registration of scoping review protocol titeled “Educational strategies capable of promoting a culture of patient safety in the surgical environment: scope review protocol”. This protocol follows the methodology proposed by Joanna Briggs Institute for scoping reviews. To the best of the authors knowledge, no other protocol within this field has been made available to the public.

The widespread use of high-dose oxygen, to avoid perioperative hypoxemia along with WHO-recommended intraoperative hyperoxia to reduce surgical site infections, is an established clinical practice. However, growing pathophysiological evidence has demonstrated that hyperoxia exerts deleterious effects on many organs, mainly mediated by reactive oxygen species. The purpose of this narrative review was to present the pathophysiology of perioperative hyperoxia on surgical wound healing, on systemic macro and microcirculation, on the lungs, heart, brain, kidneys, gut, coagulation, and infections. We reported here that a high systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation, activation of hemostasis, acute and chronic lung injury, coronary blood flow disturbances, cerebral ischemia, surgical anastomosis impairment, gut dysbiosis, and altered antibiotics susceptibility. Clinical studies have provided rather conflicting results on the definitions and outcomes of hyperoxic patients, often not speculating on the biological basis of their results, while this review highlighted what happens when supranormal PaO2 values are reached in the surgical setting. Based on the assumptions analyzed in this study, we may suggest that the maintenance of PaO2 within physiological ranges, avoiding unnecessary oxygen administration, may be the basis for good clinical practice.

Gangguan tidur dapat mempengaruhi penurunan toleransi nyeri, dan pemulihan pasca pembedahan ortopedi. Penelitian ini bertujuan untuk mengeksplorasi literatur terkait faktor – faktor yang mempengaruhi kualitas tidur pasien ortopedi pasca pembedahan yang menjalani rawat inap. Metode yang digunakan adalah dengan menganalisis artikel yang diperoleh dari database online Universitas Indonesia (ScienceDirect, Clinical Key, SAGE Journals) dan PubMed dengan menggunakan kata kunci Sleep disturbance, factors affecting sleep, sleep quality among orthopaedic patients, sleep on surgical patients, insomnia, sleep, hospitalization . Jurnal yang diperoleh dinilai menggunakan Critical Appraisal Skills Programme (CASP), dengan kriteria artikel yang dipilih dalam penulisan ini adalah memiliki desain cross sectional, cohort study, Randomized Controlled Trial (RCT),case control/series dan qualitative Research , full text,open access dan dipublikasi tahun 2014-2019, serta berbahasa Inggris. Hasilnya diperoleh lima artikel kuantitatif dan dua artikel kualitatif. Berdasarkan studi literatur yang dilakukan didapatkan bahwa nyeri, kebisingan, lingkungan (suhu, dan pencahayaan), dan faktor psikologi merupakan faktor – faktor yang mempengaruhi kualitas tidur pasien pasca pembedahan. Nyeri merupakan faktor terbanyak penyebab gangguan tidur. Pengetahuan perawat tentang pentingnya kualitas tidur dan faktor yang mempengaruhi sangat diperlukan untuk mengantisipasi terjadinya gangguan tidur yang dapat menghambat proses pemulihan pasien pasca pembedahan. ABSTRACT Sleep disturbance can reduce patients’ pain tolerance, and interrupt post-operative rehabilitation. This study aims to explore literature relating to factors that affecting sleep quality in post-operative orthopaedic patients undergoing hospitalization. The method used is the study of literature through Universitas Indonesia online database (ScienceDirect, Clinica Key, Sage journals) and PubMed by using sleep disturbance, factors affecting sleep, sleep quality among orthopaedic patients, sleep on surgical patients, insomnia, sleep, and hospitalization as keywords. The acquired journal was measured using Critical Appraisal Skills Program (CASP), with article criteria as follow: cross-sectional design, cohort study, Randomized Controlled Trial (RCT), Case-control/series and Qualitative Research, full text, open access, written in English and published years between 2014 and 2019. The results were obtained 5 quantitative journals and two qualitative journals. Based on literature studies conducted, pain, noise, environment (temperature, and lighting), and psychological factors are factors that affecting sleep quality among surgical patients. Pain is the dominant factor that affects sleep. Nurses' knowledge about the importance of sleep quality and factors that cause sleep disturbance are needed to anticipate sleep disturbance in the future that can affect post-operative rehabilitation.

Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients. This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of ≤26; the 1 standard deviation decline from baseline; the 2 scores decline from baseline; and the Z score of ≥1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated. The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%–98.1%) and specificity (82.2%, 95% CI 76.2%–88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728–0.921, P

Objetivo: Analizar los factores atribuibles a la cancelación de cirugías de una institución de salud de tercer nivel en la ciudad de Valledupar, Cesar, Colombia (2017-2018). Material y métodos: Estudio descriptivo, retrospectivo, transversal. Se recopilaron datos del archivo de casos adversos de la unidad quirúrgica del hospital para 6 especialidades quirúrgicas. Resultados: Mostraron que en 2017 hubo una suspensión quirúrgica del 4% del total de cirugías programadas que fueron (3339), para 2018 la tasa fue del 3% con un total de cirugías programadas (1733). La razón de la suspensión para ambos períodos fue el factor relacionado con las condiciones adversas del paciente con 45.9 y 38.5% respectivamente. La especialidad más afectada para estos casos fue la especialidad de cirugía general con el mismo valor porcentual en ambos períodos del 4%. Conclusión: Los resultados nos dan una idea de los factores presentes para la cancelación de cirugías programadas y la necesidad de aplicar medidas para garantizar la seguridad del paciente. Objective: To analyze the factors attributable to the cancellation of surgeries of a third level health institution in the city of Valledupar, Cesar / Colombia (2017-2018). Material and methods: Descriptive, retrospective, cross-sectional study. Data from the hospital surgical unit adverse case file were collected for 6 surgical specialties. Results: They showed that in 2017 there was a surgical suspension of 4% of the total of scheduled surgeries that were (3339), for 2018 the rate was 3% with a total of scheduled surgeries (1733). The reason for the suspension for both periods was the factor related to the patient's adverse conditions with 45.9 and 38.5% respectively. The specialty most affected for these cases was the specialty of general surgery with the same percentage value in both periods of 4%. Conclusion: The results give us an idea of the factors present for the cancellation of scheduled surgeries and the need to apply measures to guarantee patient safety.

Background: cognitive impairment is known to be very common in patients with hip fractures, but studies are needed to help understand the relationship between both events. Our goal was to determine the relationship between moderate or severe cognitive impairment and hip fractures during the six months following that episode. Methods: a retrospective longitudinal study was conducted on a sample of 665 people over 65 years of age. The main variable of the study was cognitive impairment at six months of fracture, assessed using the Pfeiffer scale (PS). Other data related to clinical features were also collected for further analysis. Results: binary logistic regression analyses showed that the main factors related to moderate or severe cognitive impairment at the sixth month of the fracture were age (OR = 1.078), initial cognitive impairment (OR = 535.762), and discharge (OR = 547.91), cognitive worsening at the sixth month with respect to the time of admission (OR = 7.024), moderate dependence on admission (OR = 15.474) and at six months (OR = 8.088), poor ambulation at discharge (OR = 5.071) and institutionalization prior to admission (OR = 5.349) or during the first semester after fracture (OR = 6.317). Conclusions: this research provides evidence about the clinical factors that predict moderate or severe cognitive decline at the sixth month in patients undergoing surgery for a hip fracture.

Introducción: el instrumentador quirúrgico cumple un papel importante en la atención del paciente quirúrgico, involucrándose en la manipulación de medicamentos que pueden generar incidentes y eventos adversos (EA). El presente estudio describe los EA publicados que ocurrieron durante la atención intraoperatoria. Materiales y métodos: revisión de la literatura en las plataformas Cochrane, MEDLINE, Embase y bases de datos de literatura de salud Pubmed, OVID, UptoDate y Scielo entre 2006 y 2017. Resultados: se localizaron 1.747 documentos eliminándose 1.697 por no cumplir con criterios de inclusión y de los 50 restantes se descartaron 41 por no contar con información de interés para el presente estudio. Conclusiones: aunque en los quirófanos los EA asociados con la manipulación de medicamentos no es infrecuente, se requieren más estudios con alto nivel de evidencia que permitan asociar la práctica asistencial del instrumentador quirúrgico con dichos EA intraoperatorios.

This study aimed to investigate the spread of methicillin-resistant coagulase-positive staphylococci (MRCoPS) among veterinary staff, hand-touch sites and surgical tissue during cystotomy operations on cats and dogs that were patients, and to analyze the genetic relatedness and antimicrobial resistance profiles of the isolates. Human and environmental samples were obtained from the nasal passageways of 12 surgeons and veterinary assistants and from 29 hand-touch sites of instruments in operative units and subjected to bacterial isolation and enumeration. Swab samples were collected in triplicate from 29 dogs and three cats at the site of incision, from the incision area, from the peritoneum during surgery and from the peritoneum before suture. MRCoPS were identified by mecA gene detection and characterized by their antibiogram profile, SCCmec type and pulsed-field gel electrophoresis. Twenty-four staphylococci were isolated, derived from one veterinary assistant, 12 operating room floor areas and hand-touch sites, three dogs and one cat. Methicillin-resistant S. pseudintermedius (MRSP) was found on an electric clipper and rebreathing circuits in the operating room. Three dogs were positive for MRSP during surgery, and one methicillin-resistant S. aureus (MRSA) was detected in a cat. All MRCoPS were resistant to doxycycline, erythromycin, clindamycin and enrofloxacin, but no patients developed surgical site infections. According to their genotypic patterns, the clones obtained from the environment and human sources differed from the animal clones. Despite intensive hygienic management, a variety of MRCoPS clones were present within the surgical unit and during surgery.

The term 'malnutrition' is a broad term used to describe any imbalance in the diet. In 2009 it was confirmed that malnutrition is an urgent health problem. The reasons for which malnutrition may develop are different. Loss on cellular, physical and physiological level happens as a consequence of malnutrition. Studies show that in surgical practice there is malnutrition in 50% of patients and that there is an association between inadequate nutritional status and surgical result. It leads to prolonged treatment, increasing of the level of morbidity and mortality, increased hospital costs, etc. Sometimes malnutrition is unrecognised, untreated and worsened in hospitals. For this reason this paper will elaborate: nutrition and a surgical patient, assessment of a nutritional status, assessment of energy requirements, and enteral and parenteral nutrition in order to determine the conditions and procedures that affect the appearance, recognition and treatment of malnutrition.

Introduction: Surgical procedures include invasive surgical techniques that affect the patients’ physical and psychosocial status and increase the levels of anxiety. Aim: To assess the relationship between the preoperative information provided to surgical patient and the preoperative anxiety. Methodology: The research study took place between September and December 2015 using a descriptive correlational design. The study sample consisted of 124 surgical patients of a general hospital of the region of Attiki, Athens. Inclusion of participants in the study was based on specific criteria. Data were collected by using a questionnaire, developed by the researchers after an extensive literature review and the anxiety depression scale HADS (Hospital Anxiety and Depression Scale). Ethical procedures were taken into account throughout the research study. Data analysis was performed using SPSS 19.0 statistical program. Results: The majority of the patients (70.2%), stated that they were satisfied by the amount of information provided, while 56.1% stated that they wished to have some additional information. Most of the patients (86.1%) reported that the preoperative information provided before surgery was very beneficial to them. The outcome of the surgical procedure (56.5%) and postoperative pain (48.4%) were strongly associated with preoperative anxiety. The desire for more information was positively correlated with depressive symptoms. Patients who wished to obtain detailed information before surgery and those who felt that the information was beneficial to them before surgery were less likely to develop symptoms of depression. The high educational level of patients appeared to have a positive correlation with preoperative anxiety. Conclusions: Provision of information at a preoperative stage can reduce preoperative anxiety and depressive symptoms. Further investigation is essential taking into account the unique characteristics and the specific needs of the patients.

Purpose:Methylphenidate (MPH) derivative drugs are used because of psychostimulants effects on attention-deficit hyperactivity disorder in children and adults. As far as we know, toxic or anti-proliferative effects of MPH against cartilage tissue were not studied in the literature. The present study was carried out to investigate the possible effects of MPH on the proliferation, viability and differentiation of primary human chondrocytes, in vitro.Methods:Monolayer primary chondrocyte cultures were prepared using osteochondral tissue obtained from patients who underwent a total knee prosthesis operation. Stock solution of MPH was prepared and aliquots having 1–1000 µM concentrations of the drug was composed. These solutions were applied to the wells containing cultured chondrocyte samples within the well plates. Control groups were composed of pure chondrocyte culture and no solution was added into them. All groups were evaluated at 24, 48 and 72 h in order to determine the possible negative effects of the drug on the chondrocytes. The data were evaluated by Tukey’s honestly significantly different test following analysis of variance.Results:In the group where MPH was applied, it was found that viability, proliferation and stage-specific embryonic antigen-1 protein expression were decreased in comparison to the control group.Conclusions:It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.

Background The use of a prophylactic antibiotic in an amputation surgery is a key element for the successful recovery of the patient. We aim to determine, from the perspective of the Colombian health system, the cost-effectiveness of administering a prophylactic antibiotic among patients undergoing lower limb amputation due to diabetes or vascular illness in Colombia. Methods A decision tree was constructed to compare the use and nonuse of a prophylactic antibiotic. The probabilities of transition were obtained from studies identified from a systematic review of the clinical literature. The chosen health outcome was reduction in mortality due to prevention of infection. The costs were measured by expert consensus using the standard case methodology, and the resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. Results In the base case, the use of a prophylactic antibiotic compared with nonuse was a dominant strategy. This result was consistent when considering different types of medications and when modifying most of the variables in the model. The use of a prophylactic antibiotic ceases to be dominant when the probability of infection is greater than 48%. Conclusions The administration of a prophylactic antibiotic was a dominant strategy, which is a conclusion that holds in most cases examined; therefore, it is unlikely that the uncertainty around the estimation of costs and benefits change the results. We recommend creating policies oriented toward promoting the use of a prophylactic antibiotic during amputation surgery in Colombia. © 2016 Elsevier Inc.

Objective To investigate the effects of hysterectomy and/or oophorectomy on sexual satisfaction. Methods Forty sexually active women underwent a hysterectomy and/or oophorectomy, for benign gynecological diseases. Patients were interviewed 15 days prior to their operation and again in the 3rd and 6th months after the surgical procedure. Depressive symptoms, anxiety symptoms and sexual satisfaction were measured by the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Golombock Rust Inventory of Sexual Satisfaction (GRISS), respectively. Repeated-measures analyses of variance (ANOVA) examined alterations in anxiety, depression and sexual satisfaction. Independent t-test and Mann-Whitney U tests compared the numerical data. Results The women had mild depressive symptoms before the surgery; however, these symptoms lessened between 3 and 6 months after the surgery. Similarly, the level of anxiety symptoms decreased during the postoperative period. Based on the GRISS cut-off point, it was found that the patients had problems in the sub-dimensions of frequency, communication, and avoidance in the pre-operative period. This pre-existing sexual dissatisfaction continued after the surgery, and sensuality and anorgasmia problems increased. Satisfaction, sensuality, avoidance and anorgasmia GRISS scores were significantly higher after the operation than before. Therefore, the patients' sexual satisfaction was decreased after the operation. Conclusions Patients were dissatisfied with frequency and communication, and they had high levels of avoidance before operation. In the postoperative period, sexual dissatisfaction increased. Although depression and anxiety decreased after the operation, we found that hysterectomy and/or oophorectomy had negative effects on sexual satisfaction. © 2011 International Menopause Society.

ObjectiveThe study describes the clinical characteristics, bacteriology and risk factors for mortality of patients with necrotizing fasciitis (NF), seen in a university medical centre.MethodsThe medical charts of NF patients admitted to the institution from January 2004 to July 2007 were retrieved and reviewed retrospectively.ResultsThe majority of the 67 patients included in the study presented with localized nonspecific inflammatory manifestations: tenderness (94%), warmth (86%), oedema (76%), skin necrosis (75%), and ulceration (68%). Diabetes mellitus (22%) was the most common predisposing medical condition. The most frequent isolates were Escherichia coli (44%), Acinetobacter baumannii (19%), Staphylococcus aureus (15%) and Enterococcus faecium (15%). Overall mortality rate was 36%. Risk factors significantly associated with mortality were truncal involvement (p = 0.034), leukocytosis (p = 0.038), acidosis (p = 0.001), hypoalbuminaemia (p = 0.004), hypocalcaemia (p = 0.000) and hyponatraemia (p = 0.023). Logistic regression analysis revealed acidosis [p < 0.05, odds ratio (OR) = 9] and hypoalbuminaemia (p < 0.05, OR = 14) as significant independent risk factors for mortality.ConclusionThe identified risk factors can inform clinicians of increased mortality risks for certain patients with NF. They should serve as a trigger for more aggressive surgical and critical care, and antimicrobial therapy for these patients.

Introduction: Pharmacological prophylaxis for venous thromboembolism is recommended for the vast majority of patients undergoing major orthopedic surgery. Increased risk of bleeding after the use of these agents has been widely documented in general population. Conversely, the frequency of this complication has not been studied in the subpopulation of elderly patients. The purpose of this study is to determine whether the risk of major bleeding after major orthopedic surgery is higher in elderly patients, compared to those operated at a younger age. Methods: We performed a retrospective cohort study including patients who underwent total hip and total knee arthroplasty during five consecutive years. Patients with other causes of bleeding were excluded. Medical records were reviewed in order to determine the occurrence and manifestation of major bleeding. A nested case-control analysis was used to determine which age group had the greatest odds ratio (OR) for major bleeding. Then, we compared two cohorts grouped by age. Relative risks (RR) and confidence intervals (CI) were calculated and a multivariate analysis was performed. Results: A total of 1048 patients were included in the analysis. Of these, 56% corresponded to hip joint replacements and 44% to knee joint replacements. The case control analysis reported that patients who were 70 years or older at the time of surgery had the highest OR (2.61) for major bleeding, therefore a limit of 70 years old was established to create two cohorts. At the time of surgery 553 (53%) patients were 70 years or older while 495 (47%) were younger. Patients who were ≥70 years old showed an increased risk of major bleeding: RR 2,42 (95% CI: 1.54-3.81). After total hip arthroplasty the RR was 2,61 (95%CI: 1.50-4.53) and after total knee arthroplasty was 2.25 (95% CI: 1.03-4.94). After the multivariate analysis, age continued to be independently associated with a higher risk of major bleeding. Conclusion: This study allows to conclude that patients who are 70 years or older are at a higher risk of major bleeding after major orthopedic surgery than younger patients. Therefore, the use of appropriate strategies to mitigate the risk in this group of patients is encouraged

Las úlceras por presión son un problema que ha ido trascendiendo a lo largo de la historia. Actualmente se hace tanto hincapié en su tratamiento como en la prevención de su aparición. Una úlcera por presión es por definición, una lesión localizada en la piel y/o el tejido subyacente, por lo general sobre una prominencia ósea, como resultado de la presión por sí sola o en combinación con fuerzas de cizallamiento. Realizar una meticulosa valoración inicial es fundamental para enfocar correctamente la prevención de este tipo de lesiones. Teniendo en cuenta que la gran mayoría de las úlceras por presión son evitables, se intentará, mediante el presente estudio conocer la incidencia de úlceras por presión en pacientes sometidos a intervención quirúrgica de 4 o más horas de duración en un hospital comarcal. El método utilizado es un estudio descriptivo transversal. La población serán los pacientes hospitalizados en el Hospital San Agustín de Avilés (Área III de Salud de Asturias) durante el año 2016. La muestra será representativa con un mínimo de 353 pacientes. La variable dependiente: Presencia de ulcera por presión. Las variables independientes: Serán datos extraídos de la valoración enfermera, la historia clínica, formularios, escalas (Braden y Barthel). La información se recogerá de la aplicación que utilizan en dicho hospital para el manejo de datos del paciente Selene 5.1 de Siemens y del programa de extracción de datos estadísticos Data Warehouse. Los datos estadísticos provendrán de análisis descriptivos univariados y bivariados. Pressure ulcers are a problem that has been emerging throughout history. Nowadays, both their treatment and prevention of its appearance is stressed. A pressure ulcer can be defined as a skin located and/or in the underlying tissue injury, usually on top of a bony protuberance, as a result of its pressure or in combination with shear forces. It is essential to make a precise initial assessment to properly bring into focus the prevention of such injuries. Taking into account that the great majority of pressure ulcers are avoidable, will attempt, through the present work to determine the incidence of pressure ulcers in patients that had had a surgical intervention during four or more hours in a regional hospital. The method used for this research is a cross-sectional descriptive study. The population will be hospitalized patients in the San Agustín Hospital in Avilés (Asturias Health Area III) during the year 2016. The sample will be representative with a minimum of 353 patients. The dependent variable: the presence of pressure ulcer. The independent variables: the data extracted from the assessment nursery, clinic history, forms and scales (Braden and Barthel). The information will be collected from the application used in the hospital for the patient data management, Selene 5.1 by Siemens and the program for data extraction Data Warehouse. The statistical data will come from univariate and bivariate descriptive analysis. Máster en Investigación en Cuidados de Salud

Objective: Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care. Method: A descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica–Oberst Patient Satisfaction Scale (LOPSS-12). Results: 150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica–Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe’s Content Validity Index was 0.76) and moderate reliability (Cronbach’s alpha = 0.70). Two variables—patient sex and the presence of comorbidities—were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses “impatient,” but also considered the nurses’ advice to be “useful.” Patients with hospital-acquired complications were more likely to perceive nurses to be “more interested in completing tasks than in listening,” although they also felt that nurses worked “conscientiously.” Conclusion: Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica–Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.

Study Objective: To compare the recovery characteristics of two widely used anesthetic techniques: remifentanyl-propofol and sevoflurane-fentanyl in a standardized ambulatory population. Design: Randomized, single-blinded study. Setting: University-affiliated medical center. Patients: 50 ASA physical status I and II patients undergoing elective ambulatory otorhinolaryngeal surgery. Interventions: Patients were randomized two groups to receive total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-fentanyl (SF group). TIVA patients received induction with propofol 1.5 mg/kg intravenously (IV) and remifentanil 0.5 ?/kg IV. The anesthesia was continued with a continuous infusion of propofol 100 ?g/kg/min and remifentanil 0.0625-0.25 ?g/kg/min. The SF group received, at induction, fentanyl 2 ?g/kg followed by propofol 1.5 mg/kg IV. Maintenance was obtained with 1 to 1.5 minimum alveolar concentration of sevoflurane and bolus of fentanyl 1 ?g/kg IV as needed. Measurements and Main Results: Early recovery times (eye opening, response to commands, extubation, orientation, operating room stay after surgery, and Aldrete score ?9) and patient satisfaction were similar between the two groups. Postanesthetic discharge scoring system (PADSS) ? 9 was significantly shorter for the TIVA group (135.9 ± 51 vs. 103 ± 32 min) (p less than 0.01) but this difference was not associated with a shorter postanesthesia care unit (PACU) length of stay. Conclusion: Early recovery times are comparable between total intravenous anesthesia and sevoflurane-based anesthesia. Even though patients in the TIVA group achieved home readiness criteria in a significantly shorter time, this technique does not shorten PACU length of stay, which depends instead on multiple nonmedical and administrative issues. © 2002 by Elsevier Science Inc.

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH).In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38).THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did.We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.Bu çalışmanın öncelikli amacı, daha önce geçirilmiş abdominal cerrahinin, total laparoskopik histerektomi (TLH) yapılabilirliği ve güvenliği üzerine etkisini değerlendirmektir.Bu retrospektif çalışmada, Şubat 2011 ve Ocak 2013 tarihleri arasında kurumumuzda gerçekleştirilen 62 TLH operas-yonun kayıtları incelendi. Laparoskopik cerrahiyi, geçirilmiş abdominal cerrahisi olsa da tüm hastalarda düşündük. Hastalar iki gruba ayrıldı. Grup 1 geçirilmiş abdominal cerrrahisi olanları, Grup 2 geçirilmiş abdominal cerrahisi olmayanları içerdi.Operasyon süresi her iki grupta da karşılaştırılabilirdi (184.43±51.0 dk. Grup1 ve 195.41±64.1 dk. Grup 2; p=0.471). İki grup arasında intraoperatif komplikasyon açısından anlamlı fark bulunmadı. Operasyon sonrası hastanede kalış süresi ve kan kaybı da karşılaştırılabilirdi. Her iki grupta da sadece 1 vakada laparotomiye geçiş yapıldı. Grup 1’de hiçbir hastada kan transfüzyonu ihtiyacı olmazken, Grup 2’de 1 hastada oldu.Çalışmamızda cerrahi geçirmiş ve geçirmemiş olan grup arasında, operasyon süresi, postoperatif kalış süresi, kan kaybı, operatif komplikasyon oranı veya açık cerrahiye geçiş oranı karşılaştırabilir bulundu. Sonuç olarak, abdominal cerrahi hikayesinin olması TLH nin güvenliğini olumsuz etkilememektedir.

Midazolam has only sedative properties. However, dexmedetomidine has both analgesic and sedative properties that may prolong the duration of sensory and motor block obtained with spinal anesthesia. This study was designed to compare intravenous dexmedetomidine with midazolam and placebo on spinal block duration, analgesia, and sedation in patients undergoing transurethral resection of the prostate. In this double-blind randomized placebo-controlled trial, 75 American Society of Anesthesiologists' I and II patients received dexmedetomidine 0.5 mu g center dot A kg(-1), midazolam 0.05 mg center dot A kg(-1), or saline intravenously before spinal anesthesia with bupivacaine 0.5% 15 mg (n = 25 per group). The maximum upper level of sensory block and sensory and motor regression times were recorded. Postoperative analgesic requirements and sedation were also recorded. Sensory block was higher with dexmedetomidine (T 4.6 +/- A 0.6) than with midazolam (T 6.4 +/- A 0.9; P < 0.001) or saline (T 6.4 +/- A 0.8; P < 0.001). Time for sensory regression of two dermatomes was 145 +/- A 26 min in the dexmedetomidine group, longer (P < 0.001) than in the midazolam (106 +/- A 39 min) or the saline (97 +/- A 27 min) groups. Duration of motor block was similar in all groups. Dexmedetomidine also increased the time to first request for postoperative analgesia (P < 0.01 compared with midazolam and saline) and decreased analgesic requirements (P < 0.05). The maximum Ramsay sedation score was greater in the dexmedetomidine and midazolam groups than in the saline group (P < 0.001). Intravenous dexmedetomidine, but not midazolam, prolonged spinal bupivacaine sensory blockade. It also provided sedation and additional analgesia.

Background: Factors affecting the mortality in elderly patients vary among different studies. This study investigates the influence of the patient-related factors, especially the effect of the diseased organ system on the mortality risk in the elderly. Methods: Records of 942 operated patients aged 70 years and over were retrospectively examined. Age, sex, site of the diseased organ system, type of admission, benign/malign nature, American Society for Anesthesiologists (ASA) score, main surgical diagnosis, method of surgical therapy and concomitant diseases were examined for their influence on the mortality. Results: There were 501 men and 441 women. Mean age was 75.5 years. Most of the patients had colorectal pathologies. Emergency surgery was carried out in 313 patients. Mortality rate was 11.8%. Cardiogenic shock was the leading cause of mortality. There was a strong linear correlation between ASA score and mortality. Logistic regression analysis concluded that higher (≥3) ASA scores, operations under emergent conditions and diseases of the colorectal and upper gastrointestinal systems were significantly associated with higher mortality rates. Conclusion: When combined with ASA score and type of admission, site of the diseased organ system may be a good indicator of mortality in the elderly patients undergoing surgery.

Purpose To evaluate the complications associated with the primary placement of a motility coupling post (MCP) in spherical porous polyethylene (PP) implants at the time of enucleation. Design Retrospective, interventional case series. Methods The records of all patients who had undergone primary enucleation and spherical PP implant with MCP insertion, and who were followed for at least six months were reviewed. The MCP was screwed to a wrapped implant to protrude 3 mm to 4 mm anteriorly. After placing the implant into the orbit, the extraocular muscles were sutured to the implant, and the Tenon capsule and conjunctiva were closed onto the MCP. When the MCP was not exposed spontaneously within two months after surgery, it was externalized with a conjunctival cut-down procedure. Results The study included 52 patients (29 male, 23 female; age range, three to 76 years). The MCP became exposed spontaneously in 10 patients (19%). In the early postoperative period, we recorded nine complications in seven patients (13%), which might be related to primary MCP placement. These included prominent MCP decentration associated with implant motility restriction (6%), preseptal cellulitis (4%), and conjunctival prolapsus (8%). An ocular prosthesis was fit successfully onto the MCP in 51 patients. During the late period, 22 complications occurred in 15 patients (29%), including excessive discharge (15%), MCP decentration (4%), implant exposure (6%), implant infection (2%), pyogenic granuloma (8%), conjunctival overgrowth over the MCP (2%), conjunctival discoloration (4%), and lax eyelid syndrome (2%). Mean follow-up time was 34 months (range, six to 68 months). Conclusions Although MCP placement in the spherical PP implant during enucleation is a useful technique, it may be associated with complications such as MCP decentration, excessive discharge, exposure, and infection of the implant.

Objective: To determine the effect of esmolol on the frequency and severity of pain and withdrawal reactions after injection of rocuronium and to compare it with lidocaine and placebo. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Single university hospital. Patients: 120 ASA physical status I and 11 patients undergoing general anesthesia for elective surgery. Interventions: Patients were randomized to receive esmolol (0.5 mg/kg), lidocaine (0.5 mg/kg), or placebo, followed by a subparalyzing dose of rocuronium. After induction of anesthesia with propofol and fentanyl, an intubating dose of rocuronium 0.6 mg/kg was given. Measurements: Patients were observed after injection of rocuronium 0.05 mg/kg, then immediately asked if they had pain in the arm. The response was assessed; discomfort, pain, and withdrawal of the hand were recorded and graded using a 4-point scale (none, mild, moderate, or severe). After the intubating dose of rocuronium, withdrawal reactions were scored as follows: (a) no pain response, (b) pain limited to the wrist, (c) pain limited to the elbow/shoulder, or (d) generalized pain response. Results: 31 patients (77.5%) in the esmolol group, 32 (80%) in the lidocaine group, and 15 (37.5%) in the placebo group reported no pain (both groups vs placebo, P < 0.001). Moderate pain was seen in only one patient receiving lidocaine, in 6 placebo patients, but in none in the esmolol group (esmolol vs placebo, P < 0.05). Severe pain was felt by 8 patients receiving placebo, but by none receiving esmolol or lidocaine (P < 0.01). Frequency of withdrawal response after rocuronium was 2.5%, 17.5%, and 40% in the esmolol, lidocaine, and placebo groups, respectively (esmolol group vs placebo, P < 0.001; lidocame group vs placebo, P < 0.05). Conclusion: Esmolol, like lidocame, reduces the frequency of pain and withdrawal reaction associated with rocuronium injection.

35th Annual Meeting of the American-Society-of-Ophthalmic-Plastic-and-Reconstructive-Surgery -- OCT 23, 2004 -- New Orleans, LA Yazici, Bulent/0000-0001-8889-1933 WOS: 000240459300009 PubMed: 16935232 Purpose: To evaluate the technical properties and clinical efficacy of bicanalicular silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction. Methods. The Ritleng method was used for lacrimal intubation in 50 eyes of 42 consecutive patients (mean age, 37.3 months). All procedures were done by or under the supervision of one surgeon. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The polypropylene (Prolene) thread-guide, attached to the silicone tube, was advanced through the probe. Either the Prolene emerged from the nose spontaneously or it was retrieved using a hook without visualization. The tube ends were sutured to the nasal wall. Tube removal was planned for 3 months postoperatively. Resolution of signs and symptoms of lacrimal obstruction was assessed. The mean follow-up time was 18.1 months (range, 3 to 48 months). Results. The silicone tube was placed successfully in all eyes except 1 (98%). The mean procedure time was 26 minutes for each eye (range, 15 to 45 minutes). Both Prolene guides spontaneously emerged from the nose in only 8 eyes (16%). In the others, one or both Prolene guides were retrieved with a hook. Inadvertent tube dislodgement occurred in 21% of the eyes and required early tube removal. Success, ie, relief of signs and symptoms, was achieved in 86% of eyes. Conclusions:The Ritleng method of intubation for congenital nasolacrimal duct obstruction yields a high rate of success. Contrary to previous reports, our experience suggests that the surgeon must be prepared to retrieve the Prolene guide from the nose. Amer Soc Ophthalm Plast & Reconstruct Surg

Background General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Methods Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1=poor to 4=excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (ΔPaO 2 ), and hospital stay were assessed. Results There was no mortality. There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions. Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy. Comparisons of awake versus control group results showed that in the awake group, anesthesia satisfaction score was greater (4 vs 3, p = 0.04), whereas ΔPaO 2 (-3 mm Hg vs –6.5 mm Hg, p = 0.002); nursing care (2.5 calls per day vs 4 calls per day, p = 0.0001), and hospital stay (2 days vs 3 days, p = 0.02) were significantly reduced. Conclusions In our study, awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible. It resulted in better patient satisfaction, less nursing care and shorter in-hospital stay than procedures performed under general anesthesia.

To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia.Thirty-nine patients with achalasia (25 males, mean age 42+/-13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1=no symptoms; 4=persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30+/-34 mmHg. Six patients had undergone previous pneumatodilation.No procedure related mortality was recorded. Mean follow-up was 107+/-30 months (54-177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3+/-8.3 mmHg (P0.001) in oesophageal width was 11.5+/-7.1 mm (P0.001) in dysphagia 1.8+/-0.8 (P0.001) and regurgitation 1.4+/-0.7 (P0.001) Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement (P0.001) especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure.Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia.

Objective: This study aims to investigate the prevalence of administration problems with injection of low molecular weight heparins at home. Low molecular weight heparins have to be injected by patients who have undergone total hip replacement or total knee replacement surgery. Some patients might have difficulties with self-administration of low molecular weight heparins. Design and methods: A retrospective telephone interview was conducted among patients who had undergone total hip replacement or total knee replacement surgery in one of the three participating Dutch hospitals in 2008. Several questions were asked to measure health-care resource use and potential administration problems related to parenteral thromboprophylaxis. Results: 687 patients (response rate 87%) were interviewed. A total of 511 (74%) of these patients used parenteral thromboprophylaxis at home. Around 20% of the patients that used parenteral thromboprophylaxis faced problems with self-administration. Home-care visits for parenteral administration problems were required in approximately one out of ten of these orthopaedic patients. Almost 60% of all patients prefer oral above parenteral thromboprophylaxis. Conclusion: This study suggests that a small but non-negligible part of patients with total hip or total knee replacement experience problems with self-administration of parenteral thromboprophylaxis in the home setting. These patients might benefit from newer oral antithrombotic agents. Moreover it is likely that oral antithrombotic agents will be cost-saving among these patients compared to heparins, as costs of home-care for administration will be averted.