scholarly journals SP1.2.7Developing a fast- track pre-assessment pathway for laparoscopic cholecystectomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shoura Karar ◽  
Stephanie Berry ◽  
Carin Dear ◽  
Anne-Marie Day ◽  
Natalie Jones ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Fast Track ◽  
Activity Index ◽  
Health Screening ◽  
Assessment Process ◽  
Screening Questionnaire ◽  
Blood Tests ◽  
Reliable Assessment ◽  
Duke Activity Status Index ◽  
Status Index

Abstract Aims To develop a safe and reliable assessment process for patients undergoing laparoscopic cholecystectomy and negate the need for formal pre- assessment. Methods A system consisting of a health screening questionnaire completed by patients (previous general anaesthesia, cardiac and respiratory history, bleeding disorders and medications) along with a functional capacity assessment (Duke Activity Status Index), allied with screening blood tests was developed. Only patients who passed all 3 components were fast-tracked to surgery while the remainder proceeded to formal pre-assessment. Results Data was collected and analyzed on 90 consecutive patients. An interim analysis identified the format of some questions needed to be altered to facilitate patient completion, resulting in 59% (rather than 36%) of patients successfully fulfilling the fast-track criteria and not excluded by incomplete entries. Overall, 40 of the 90 patients (44%) successfully completed the fast-track assessment of whom 38 underwent surgery (2 waiting). Six patients incorrectly passed the assessments due to misinterpretation of the Duke Activity Status Index but proceeded to surgery. All 38 patients had an uneventful peri-operative course. 45 of the 50 patients who failed fast-track assessments subsequently passed formal nurse-led pre-assessment, as did 4 of the remaining 5 patients after anaesthetic review – all had an uneventful peri-operative course. Conclusion Pre-assessment driven by a health screening questionnaire, activity index and simple blood tests is safe, reduced formal pre-assessment by 44% and avoids delays. Such tools may have a significant resource impact in appropriate patient populations. The health screening questionnaire needs further revision.

Fast-track anesthesia for laparoscopic cholecystectomy: A multicenter randomized comparison between sevoflurane/remifentanil and desfluorane/remifentanil

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 161
Author(s):  
M. Berti ◽  
M. Zasa ◽  
M. Dambrosio ◽  
Y. Leikin ◽  
G. Della Rocca ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Fast Track

scholarly journals Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

2014 ◽  
Author(s):  
Mariana A. Coutinho-Myrrha ◽  
Rosângela C. Dias ◽  
Aline A. Fernandes ◽  
Christiano G. Araújo ◽  
Mark A. Hlatky ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Duke Activity Status Index ◽  
Status Index

Relation of clinical and angiographic factors to functional capacity as measured by the Duke Activity Status Index

1991 ◽  
Vol 68 (9) ◽  
pp. 973-975 ◽  
Author(s):  
Charlotte L. Nelson ◽  
James E. Herndon ◽  
Daniel B. Mark ◽  
David B. Pryor ◽  
Robert M. Califf ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Duke Activity Status Index ◽  
Status Index

Protecting Vulnerable Refugees: Procedural Fairness in the Australian Fast Track Regime

2018 ◽  
Vol 41 (3) ◽  
Author(s):  
Emily McDonald ◽  
Maria O'Sullivan
Keyword(s):  
Asylum Seekers ◽  
Fast Track ◽  
Due Process ◽  
Procedural Fairness ◽  
Assessment Process ◽  
Refugee Status ◽  
Efficiency Measures ◽  
Application Procedure ◽  
Visa Application ◽  
High Standards

Refugee Status Determination is a powerful example of the way in which vulnerability and the law interact. This article examines this interaction by analysing a case study: the special protection visa application procedure in place for certain asylum seekers in Australia (the ‘Fast Track Assessment’ process) and the implications of this for procedural fairness. We conclude that the current legislative framework for the Fast Track Assessment process operates to exacerbate the circumstances of vulnerability of asylum seekers. Efficiency measures are an important way of avoiding delays in decision-making. However it also increases the propensity of such measures to lead to serious legal errors. Considering the serious consequences of an improperly made decision in this context, we argue that high standards of procedural fairness and an oral hearing are required. The article also demonstrates that a central purpose of due process should be to mitigate (rather than exacerbate) circumstances of vulnerability or marginalisation.

A health screening and promotion clinic to improve metabolic monitoring for patients prescribed antipsychotic medication

2013 ◽  
Vol 30 (2) ◽  
pp. 113-118 ◽  
Author(s):  
D. Gallagher ◽  
M. Buckley ◽  
C. Kenny ◽  
C. Onwudiwe ◽  
C. Young ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Practice Guidelines ◽  
Best Practice ◽  
Health Screening ◽  
Local Resource ◽  
Blood Tests ◽  
Best Practice Guidelines ◽  
Metabolic Monitoring

ObjectivesWe sought to determine whether the introduction of a health screening and promotion clinic might serve as a useful addition to existing services for patients prescribed antipsychotic medication. In particular, we wished to assess whether such a clinic might improve adherence to best practice guidelines. We also wished to determine the level of patient interest in such a clinic and how readily this service might be provided within the constraints of existing clinical resources.MethodsWe conducted an audit of outpatient records before and following the introduction of a health screening and promotion clinic.ResultsOf the eligible patients, 73% attended the clinic. The proportion of patients who had fasting blood tests within the previous 12 months increased from 45% at baseline to 85% at follow-up (χ2 = 14.1, p < 0.001). The proportion of patients with appropriate physical observations completed increased from 5% at baseline to 80% at follow-up (χ2 = 46.0, p < 0.001).ConclusionsWe found that the introduction of a health screening and promotion clinic improved adherence to best practice guidelines. This service was well received and readily provided within the constraints of existing resources. Ultimately, the structure of services to screen and advise patients prescribed antipsychotic medication will be determined by local resource considerations and configuration of services.

scholarly journals Microvascular Assessment of Ranolazine in Non-Obstructive Atherosclerosis

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Jin-Sin Koh ◽  
Olivia Y. Hung ◽  
Parham Eshtehardi ◽  
Arnav Kumar ◽  
Rani Rabah ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Nonobstructive Coronary Artery Disease ◽  
Angina Frequency ◽  
Duke Activity Status Index ◽  
Artery Disease ◽  
Status Index ◽  
Frequency Score

Background: Microvascular dysfunction is known to play a key role in patients with angina and nonobstructive coronary artery disease. We investigated the impact of ranolazine among patients with angina and nonobstructive coronary artery disease. Methods: In this randomized, double-blinded, placebo-controlled pilot trial, 26 patients with angina once weekly or more, abnormal stress test, and nonobstructive coronary artery disease (<50% stenosis by angiography and fractional flow reserve >0.80) were randomized 1:1 to ranolazine or placebo for 12 weeks. Primary end point was ΔSeattle Angina Questionnaire (SAQ) angina frequency score. Baseline and 3 months follow-up SAQ, Duke Activity Status Index scores along with invasive fractional flow reserve, coronary flow reserve (CFR), hyperemic myocardial resistance, and cardiopulmonary exercise testing measurements were performed. Results: No significant differences in ΔSAQ angina frequency scores ( P =0.53) or Duke Activity Status Index ( P =0.76) were observed between ranolazine versus placebo, although patients on ranolazine had lesser improvement in SAQ physical limitation scores ( P =0.02) compared with placebo at 3 months. There were no significant differences in ΔCFR or Δhyperemic myocardial resistance between ranolazine and placebo groups. Patients treated with ranolazine, compared with placebo, had no significant improvement in maximum rate of oxygen consumption measured during incremental exercise (VO 2 max) and peak metabolic equivalents of task. Interestingly, in the ranolazine group, patients with baseline CFR<2.0 demonstrated greater gain in CFR compared with those with baseline CFR≥2.0 ( P =0.02). Conclusions: Ranolazine did not demonstrate improvement in SAQ angina frequency score, invasive microvascular function, or peak metabolic equivalent compared with placebo at 3 months. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02147067.

Fast-track anaesthesia for laparoscopic cholecystectomy

2006 ◽  
Vol 23 (10) ◽  
pp. 861-868 ◽  
Author(s):  
G. Fanelli ◽  
M. Berti ◽  
A. Casati
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Fast Track
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