Adapted ERAS Pathway Versus Standard Care in Patients Undergoing Emergency Surgery for Perforation Peritonitis—a Randomized Controlled Trial

Author(s):  
A. R. Pranavi ◽  
Sathasivam Sureshkumar ◽  
Thulasingam Mahalakshmy ◽  
Pankaj Kundra ◽  
Vikram Kate
2016 ◽  
Vol 34 (16) ◽  
pp. 1921-1927 ◽  
Author(s):  
David W. Kissane ◽  
Talia I. Zaider ◽  
Yuelin Li ◽  
Shira Hichenberg ◽  
Tammy Schuler ◽  
...  

Purpose Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. Patients and Methods Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. Results On the CGI, a significant treatment effect (Wald χ2 = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ2 = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ2 = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. Conclusion Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder.


2015 ◽  
Vol 172 (10) ◽  
pp. 1004-1013 ◽  
Author(s):  
Tong Guo ◽  
Yu-Tao Xiang ◽  
Le Xiao ◽  
Chang-Qing Hu ◽  
Helen F.K. Chiu ◽  
...  

2019 ◽  
Vol 84 ◽  
pp. 105828 ◽  
Author(s):  
Chamara Basnayake ◽  
Michael A. Kamm ◽  
Michael Salzberg ◽  
Angela Khera ◽  
Danny Liew ◽  
...  

2020 ◽  
Vol 29 (19) ◽  
pp. S40-S46
Author(s):  
Amanda Corley ◽  
Amanda J Ullman ◽  
Nicole Marsh ◽  
Larsen Emily N. ◽  
Gabor Mihala ◽  
...  

Introduction Peripheral intravenous catheters (PIVCs) are widely used, but failure is unacceptably common with up to 69% failing before treatment is complete. PIVC securement reduces failure, but the optimal way to achieve this is unclear. Tapes and supplementary securement products are widely used, however rigorous testing of these to reduce PIVC failure remains unexplored. Methods and analysis In adult medical-surgical wards at a tertiary hospital, this pilot randomized controlled trial tests standard care (bordered polyurethane dressing plus nonsterile tape over the extension tubing) against two securement interventions (intervention one: standard care plus two sterile tape strips over the PIVC hub; intervention two: intervention one plus a tubular bandage). Patients >18 years of age requiring a PIVC for >24 hours are eligible. Patients with laboratory-confirmed positive blood cultures within 24 hours of screening, known allergy to study products, current or high-risk of skin tear, or non-English speaking without interpreter are excluded. Sample size is 35 per trial arm, and central randomization is computer-generated with allocation concealed until entry. Patients and clinical staff cannot be blinded to treatment allocation. However, infection outcomes are assessed by a blinded investigator. Primary outcome is study feasibility. Secondary outcomes (PIVC failure, dwell time, skin adverse events, PIVC colonization, and cost) are compared between groups. Feasibility outcomes are reported descriptively. Ethics and trial commencement Ethical approvals were received from Royal Brisbane and Women's Hospital (HREC/18/QRBW/44571) and Griffith University (2018/1000). Trial commencement was May 2019. Trial registration: ACTRN12619000026123.


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