scholarly journals SP10.2.9 An audit of consenting practice for elective surgical procedures and patients overall satisfaction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Khaled Noureldin ◽  
Afsheen Mehmood ◽  
Abraham Ayantunde
Keyword(s):  
Surgical Procedures ◽  
Visual Analogue Score ◽  
Satisfaction Score ◽  
Consent Form ◽  
Satisfaction Level ◽  
Patients Satisfaction ◽  
Elective Surgical Procedures ◽  
Process Procedures ◽  
The Mean ◽  
Mean Time

Abstract Introduction We evaluated our consenting practice for surgical procedures and patients’ satisfaction. Patients and Methods 100 patients were evaluated for the timing, details, understanding and satisfaction with the consenting process. Procedures were elective general and colorectal operations. Patients’ overall satisfaction level was rated on visual analogue score. Results 54 males and 46 females were included, median age was 65 (16-93) years. The mean time between consenting and surgery was 29 (0-358) ± SD 73 days. Legible writings in 88% with completed details in 51%. The names of the responsible surgeon were missing in 49%. All patients fully understood the intended procedure and its possible outcomes. 99% were comfortable with the consenting environment. One patient preferred a different setting and an earlier date. Two patients felt the consenting process was performed in a hurry, but all patients submitted that they had enough time to reflect on the consent and the procedure before surgery. The overall satisfaction levels were excellent in 93% (9&10), good in 5% (7&8) and fair in 2% (5&6). One patient with low satisfaction score was unhappy with the anaesthetist. Conclusion Improvement in the legibility and completeness of the consent form are to be encouraged. The overall patients’ satisfaction was good to excellent.

scholarly journals Determining Model for Maximum Blood Request (MSBOS) for Surgery: An Elective Surgery in Imam Ali Hospital, Zahedan, Iran

2019 ◽  
Author(s):  
Seyed Mehdi Hashemi ◽  
Seyed Hossein Soleimanzadeh Mousavi ◽  
Zeinab Tavakolikia
Keyword(s):  
Surgical Procedures ◽  
Blood Donation ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Blood Transfusions ◽  
Hernia Surgery ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
The Mean ◽  
Common Problems

Background: Nowadays, excessive blood intake is one of the most common problems in educational hospitals, causing issues such as the lack of proper distribution of blood products among centres, increases in costs and blood bank workloads. So, programs such as a Maximum Surgical Blood Ordering Schedule (MSBOS) were introduced to design a blood ordering schedule, which is a guide to normal transfusion needs for common surgical procedures.  Materials and Methods: This study was a descriptive cross-sectional study. The sampling method was designed and distributed among all sectors of the hospital. Each sector according to the demand for blood and cross-matched transfused units entered the rate of wasted and unused blood bags on the related forms. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. Results: The aim of this study was to determine the pattern for the maximum surgical blood order schedule (MSBOS) for elective surgical procedures/in elective surgery cases in Imam Ali Hospital, Zahedan. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. The mean C/T ratio was 1.61 ± 0.99, the mean TI was 0.61 ± 0.38, and the mean T index was 36.4 ± 30.16%. Conclusion: In general, only 55% of the blood units were used. Hernia surgery, thyroidectomy, and patients with renal problems had the greatest number of wasted units. Therefore, according to the results, indications of blood donation should be made correctly by health care personnel in all patients requiring a blood transfusion, and if there is an increased number of indications, packed cells are requested.  

scholarly journals Simultaneous Bilateral Video-Assisted Thoracoscopic Surgery for the Treatment of Primary Spontaneous Pneumothorax

2014 ◽  
Vol 71 (3) ◽  
pp. 1703-1708 ◽  
Author(s):  
Xin Wang ◽  
Lei Wang ◽  
Huayong Wang ◽  
Hao Zhang
Keyword(s):  
Surgical Procedures ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Primary Spontaneous Pneumothorax ◽  
Intraoperative Bleeding ◽  
Video Assisted ◽  
Second Surgery ◽  
The Mean ◽  
Mean Time ◽  
Video Assisted Thoracoscopic Surgery

Abstract We determined the feasibility and clinical efficacy of simultaneous bilateral video-assisted thoracoscopic surgery (VATS) for treating primary spontaneous pneumothorax (PSP). We performed a retrospective analysis of the efficacy of simultaneous bilateral resection of pulmonary bullae using VATS in 21 PSP patients that were treated at our hospital from February 2010 to August 2013. We found bilateral bullae in all patients through the intraoperative exploration. Surgical procedures were successfully completed in all patients without conversion to thoracotomy. The mean time of surgery was 128.76 ± 13.82 min (range 100–150 min). Total amount of intraoperative bleeding was 80–200 ml. Total drainage of bilateral thoracic ducts was 200–500 ml at the 1st postoperative day with a mean drainage of 321.42 ± 82.66 ml. Bilateral thoracic ducts were removed 4–8 days postoperatively with a mean time of 4.7 days. The duration of postoperative hospitalization was 5–9 days with a mean duration of 7 days. No patient had serious complication(s) and all patients were discharged after full recovery. The patients were followed up for 6–18 months after the surgery and no relapse occurred. In conclusion, treating the unilateral PSP by simultaneous bilateral VATS is safe and effective. It reduces patients’ risk of second surgery and also minimizes patients’ suffering and costs incurred.

The effect of premedication on the induction dose of propofol in dogs and cats

1991 ◽  
Vol 62 (3) ◽  
pp. 118-123 ◽  
Author(s):  
Judith K. Geel
Keyword(s):  
Surgical Procedures ◽  
Induction Agent ◽  
Induction Dose ◽  
Elective Surgical Procedures ◽  
The Mean

The effect of premedication on the induction dose of propofol was determined in 15 cats and 25 dogs undergoing elective surgical procedures. The induction dose of propofol in dogs younger than 8 years old was 6,9 ± 0,9 mg kg-¹ (n=4) without premedication and 4,3 ± 1,4 mg kg-¹ (n=12) with premedication with acetylpromazine maleate. The induction dose in cats younger, than 3 years old was 7,8 ± 1,1 mg kg-¹ (n=8) with atropine alone and 7,1 ± 0,9 mg kg (n=7) with the inclusion of acetylpromazine maleate. The reduction in the induction dose of propofol was statistically significant in dogs, hut not in cats. When atropine was used together with a fentanyl-droperidol combination or pethidine and acetylpromazine maleate in dogs, the mean induction dose of propofol was reduced to 2,1 ± 0,1 mg kg (n=4) and 2,4 ± 0,3 mg kg-¹ (n=5), respectively. Propofol was also evaluated as an induction agent in patients undergoing non-elective surgical procedures.

scholarly journals Reduction of Acute Anterior Shoulder Dislocation Using Intraarticular Lidocaine(IAL) and Stimson’s Technique

2012 ◽  
Vol 10 (1) ◽  
pp. 6-8
Author(s):  
BB Thapa ◽  
P Chand ◽  
N Kayastha ◽  
S Rana ◽  
NB KC ◽  
...  
Keyword(s):  
Medical Journal ◽  
Observational Study ◽  
Shoulder Dislocation ◽  
Prospective Observational Study ◽  
Visual Analogue Score ◽  
Anterior Shoulder Dislocation ◽  
The Mean ◽  
Mean Time

Introduction: Shoulder dislocation is common injury requiring urgent reduction. For the reason that patient is not nill orally and anesthetists are not available, reduction under intra venous anaesthesia is not possible. This study was aimed to evaluate the effectiveness of intraarticular lidocaine and stimson’s technique of shoulder dislocation, which could be performed without anesthetist and irrespective of nill orally status. Methods: A prospective observational study was performed from December 2009 to December 2010. Under all antiseptic precautions 20 ml of Lidocaine was injected intraarticularly and reduction was performed by Stimson’s technique. Visual Analogue Score, time for reduction and failure to reduction by this technique was recorded. Results: Out of 27 dislocations 22 were successfully reduced and remaining required added scapular manipulation. The mean VAS scor was 2.3±1.26 and the mean time of reduction was 17.96±1.9 minutes. Conclusion: Stimson’s method with Intraarticular Lidocaine is effective, safe, less costly and can be performed in periphery where anesthetist and monitoring facilities are not available. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6406 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 6-8

scholarly journals Prognosis of gliomas in the 1970s and today

2005 ◽  
Vol 18 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Joachim Oertel ◽  
Ekaterina von Buttlar ◽  
Henry Werner Siegfried Schroeder ◽  
Michael Robert Gaab
Keyword(s):  
Mr Imaging ◽  
Surgical Procedures ◽  
Morbidity And Mortality ◽  
Low Grade ◽  
Perioperative Morbidity ◽  
Low Grade Gliomas ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Mean Time

The benefit of the current strategy for diagnosis (magnetic resonance [MR] imaging) and treatment (surgery, chemotherapy, radiotherapy) of gliomas, in contrast to the standard treatment in use before MR imaging and the micro-surgical era, has not yet been determined. A retrospective statistical analysis was performed for all patients with glioma who underwent surgery at a single institution between 1965 and 1974 (Group I, 88 patients) or 1986 and 1995 (Group II, 249 patients). There were no major differences in symptomatology, tumor localization, and number of surgical procedures. The mean time until tumor diagnosis was significantly shorter in Group II (Group I, 48 weeks; Group II, 19.5 weeks). Also, the mean time from initial symptoms to surgery was significantly shorter for high-grade gliomas in Group II (Group I, 16.3 weeks; Group II, 11.7 weeks). For high- as well as low-grade gliomas, there was a clear reduction of the perioperative morbidity and mortality rates in Group II. Nevertheless, for the postoperative duration of survival, no significant differences were demonstrated for high- or low-grade gliomas. Based on the results of this study, the perioperative morbidity and mortality rate as well as the time from diagnosis to treatment have been remarkably reduced within the last 30 years. Nevertheless, the overall prognosis for patients with gliomas has not changed from the 1970s until today. Thus, the introduction of modern diagnostic modalities and surgical procedures has not improved the outcome in patients with glioma. Further research to improve the treatment of this disease is urgently needed.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

2012 ◽  
Vol 15 (5) ◽  
pp. 251
Author(s):  
Changqing Gao ◽  
Chonglei Ren ◽  
Cangsong Xiao ◽  
Yang Wu ◽  
Gang Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Procedures ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
The Mean

<p><b>Background:</b> The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>Methods:</b> Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.</p><p><b>Results:</b> All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (<i>P</i> = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (<i>P</i> = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.</p><p><b>Conclusions:</b> Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.</p>

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

2021 ◽  
pp. 107815522110160
Author(s):  
Bernadatte Zimbwa ◽  
Peter J Gilbar ◽  
Mark R Davis ◽  
Srinivas Kondalsamy-Chennakesavan
Keyword(s):  
Checkpoint Inhibitors ◽  
Anticancer Therapy ◽  
Mortality Rates ◽  
Feedback Process ◽  
Time To Death ◽  
Cancer Centre ◽  
Haematology Patients ◽  
The Mean ◽  
Regional Cancer Centre ◽  
Mean Time

Purpose To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. Method All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Results Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). Conclusion The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

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