scholarly journals P-OGC02 The development of an evidence based algorithm for the provision of nutrition as part of an Enhanced Recover After Surgery (ERAS) pathway in patients undergoing elective Gastrectomy and Oesophagogastrectomy for cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vida Dossou ◽  
Ally Cleary
Keyword(s):  
Nutritional Support ◽  
Clinical Symptoms ◽  
Enhanced Recovery ◽  
Care Pathway ◽  
Subtotal Gastrectomy ◽  
Nutritional Intake ◽  
Nutrition Support ◽  
Evidence Based ◽  
Operative Care ◽  
Operative Recovery

Abstract Background Following a recent merger or UGI Cancer services, a consensus was needed for the ERAS pathway nutritional elements. ERAS is a way to maintain physiological function following surgery enabling post-operative recovery without adversely affecting morbidity or mortality.  It is a coordinated pathway that enables consistent, evidence based multi-modal care. Anaesthesia, nutrition, analgesia, surgical technique and physiotherapy are active and key components of enhanced recovery along with patient involvement and empowerment.  ERAS in UGI revealed a significant reduction in LOS in most cases, by around 50% without increasing morbidity and mortality when compared to standard post-operative care.  Methods Coupling the service redesign with the publication of guidelines in ERAS and Gastrectomy, it was decided to review the evidence base for ERAS and nutrition support specific to UGI Cancer surgery.  In addition to this, aim to review the evidence for and against the use of immunonutrition (IN).  Literature searches were conducted using CINAHL and PUBMED databases. The evidence was critiqued and a consensus reached. From this evidence review, an algorithm recommending the instigation of nutrition post Upper Gastrointestinal (UGI) surgery as part of an ERAS pathway was developed.  Results An algorithm was produced standardising the nutritional care for patients undergoing elective UGI surgery in our centre, which formed part of the ERAS care pathway produced through the ERAS steering group. All patients were screened for risk of malnutrition at the start of their surgical care pathway and regularly throughout their journey, appropriate nutritional support will be provided by a specialist Dietitian to optimise the patient.   Conclusions The evidence to support the use of IN is conflicting and is not currently recommended on this ERAS pathway. Nutritional intake in the form of Oral Nutritional Support (ONS) in subtotal gastrectomy can be commenced at Day 2. Nutritional intake in the form of ONS in Total Gastrectomy can be commenced at Day 4. Nutritional intake in the form of ONS in Oesophagogastrectomy can be commenced at Day 5. After ONS tolerated without clinical symptoms, patient can be progressed to Soups, Jellies, Ice creams for 24 hours then to an UGI specific soft menu pre discharge.  

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

2020 ◽  
Author(s):  
Mengchen Yin ◽  
Yinjie Yan ◽  
Zhaoxiang Fan ◽  
Niankang Fang ◽  
Hongbo Wan ◽  
...  
Keyword(s):  
Western Medicine ◽  
Intertrochanteric Fracture ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Controlled Trial ◽  
Intramedullary Fixation ◽  
Perioperative Outcomes ◽  
Evidence Based ◽  
Randomized Controlled

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

715 Early Ambulation for Enhanced Recovery After Burn Surgery: A Systematic Review and Meta-analysis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Tomer Lagziel ◽  
Margarita Ramos ◽  
Kevin M Klifto ◽  
Stella Steal ◽  
Julie Caffrey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Burn Patients ◽  
Early Ambulation ◽  
Lengths Of Stay ◽  
Operative Care ◽  
Burn Surgery ◽  
Operative Recovery

Abstract Introduction Accurate models are a fundamental prognostic tool for risk stratification, therapy guidance, resource allocation, and comparative effectiveness research. Enhanced recovery after surgery protocols are developed to increase early post-operative recovery rates in surgical patients. Due to the unique nature of burn injuries and post-operative care, there is a need to develop a protocol unique to burn surgery, enhanced recovery after burn surgery. Methods The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines were strictly followed throughout the study. Search terms were utilized to capture the relevant studies relating to early ambulation of adult burn patients (>18 years of age) and their post-surgical outcomes such as graft take, time to discharge, pain levels, VTEs, and length-of-stay. Results Thirteen of 888 studies retrieved from the search query were eligible for systematic review and meta-analysis. Patients with delayed ambulation, after 5 or more days were found to have increased pain levels at rest (p=0.02) and when ambulating (p=0.08). One study found an increased infection rate in late ambulatory patients (p=0.22). Most results from studies did not have significant data that was relevant to our extraction. For example, only one study assessed pain levels and only three studies notes zero venous thromboembolisms (without statistical significance). Conclusions Limited evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. There are no significant differences in the number of events between early and late ambulation groups. Early ambulation should be included as part of the ERABS protocol for lower risks of hospital-acquired infections due to shorter lengths-of-stay. Decreased associated pain levels could lead to decreased risk for opioid dependence. Due to limited literature references, these conclusions are immature and more studies should be performed in order to develop more accurate and effective protocols. Applicability of Research to Practice Burn surgery recovery patients are unique. Therefore, specialized protocols must be developed to enhance their post-operative care.

scholarly journals Implementation of enhanced recovery after surgery- ERAS, a paradigm shift in surgery

2018 ◽  
Vol 5 (1) ◽  
pp. 1-2
Author(s):  
Jay Narayan Shah
Keyword(s):  
Colorectal Surgery ◽  
Social Services ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Collaborative Group ◽  
Surgical Trauma ◽  
Evidence Based ◽  
Consensus Protocol ◽  
Research Education ◽  
Operative Care

The history of enhanced recovery after surgery (ERAS) has its roots to the earlier ERAS Study Group. This was a collaborative group on peri-operative care to further develop ideas put forth in the 1990’s by Professor Henrik Kehlet of University of Copenhagen. Kehlet reported that the morbidity, mortality and overall costs of surgery requires multimodal interventions to reduce pain; cardiopulmonary, infective and thromboembolic complications; cerebral dysfunction; nausea and gastrointestinal paralysis, fatigue and prolonged recovery. The ERAS Society, registered and based in Stockholm, has over the years developed ‘perioperative care’ strategies to improve recovery after surgery through research, education, audit and implementation of evidence-based practice. An evidence-based consensus protocol for patients undergoing colon surgery was developed and published by the ERAS Study Group3 and later the group showed that just a protocol was not sufficient to change surgical practice in accordance with ERAS. The ‘manual of fast track recovery for colorectal surgery (Springer)’ was published by the ERAS Society as 1st in the series of enhanced recovery. Thereafter various professional societies and organizations around the world have worked together to develop, modify, promote and propagate ERAS. From its original work on colorectal surgery, the ERAS is now implemented in virtually all the disciplines of surgeries and the guidelines are available at ERAS Society website. The strategies of ERAS is designed for ‘preoperative, intraoperative and postoperative care’ through multimodal, integrated, multidisciplinary approach from all the stake holders: the patient, surgeons, anaesthesiologists, pain specialists, nursing staff, physical and occupational therapists, social services, and hospital administration. It advocates of the standardized medical care to improve the outcomes and lower the health care costs by minimizing surgical trauma, postoperative pain, complications, length of hospital stay, while expediting recovery and improving the overall outcomes.

scholarly journals Comparative study with or without application of enhanced recovery after surgery protocols in patients undergoing elective cesarean section

2020 ◽  
Vol 10 (1) ◽  
pp. 173
Author(s):  
Pammy Pravina ◽  
Khushbu Tewary
Keyword(s):  
Caesarean Section ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Financial Burden ◽  
Elective Caesarean Section ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Operative Care ◽  
Operative Recovery ◽  
Eras Protocol

Background: Concept of enhanced recovery after surgery (ERAS) has been applied in various surgical branches. Evidence regarding the necessary components of ERAS for obstetric population is limited. Therefore, objective of this study was to test the application of ERAS in patients undergoing elective caesarean section on the post-operative recovery process.Methods: The study was conducted in the Department of Obstetrics and Gynecology, NMCH, Patna from January 2014 to December 2014. A total of 100 patients (n=100) undergoing elective caesarean section were included in the study. Cases were allocated into two groups a) Study group included 60 patients (n=60) and ERAS protocol was followed b) Control group included 40 patients (n=40) and standard post-operative care protocol was followed. Two groups were compared with respect to recovery parameters, post-operative complications and satisfaction rates.Results: More patients in the ERAS group were discharged on post-operative day 4 than the standard postoperative care group (90% vs 12.5%, p<0.0001). More patient in the ERAS group were significantly satisfied with the protocol compared to standard post-operative care (77% vs 70%, p<0.04). Approximately 77 percent of the patients in the ERAS group rated the satisfication score between 8-10 compared to 70 percent of the patients in control group (p<0.04). There was no difference between two groups with respect to recatheterization rate, readmission rate and post-discharge complaints.Conclusions: In this study with application of ERAS protocol, we reported reduced hospital stay which may reduce financial burden of patients and healthcare facilities.

scholarly journals The efficacy of enhanced recovery after surgery for elderly patients receiving surgery for intertrochanteric fracture: a study protocol for a randomized blinded controlled clinical trial

2020 ◽  
Author(s):  
Mengchen Yin ◽  
Yinjie Yan ◽  
Zhaoxiang Fan ◽  
Niankang Fang ◽  
Hongbo Wan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Western Medicine ◽  
Intertrochanteric Fracture ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Evidence Based ◽  
Randomized Controlled

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often cause a high mortality rate in old patients and increase the economic burden of the family and society. ERAS is a powerful guarantee for patients to accelerate their recovery after surgery. TCM promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

Tennis- und Golfer-Ellenbogen

2015 ◽  
Vol 63 (4) ◽  
Keyword(s):  
Spontaneous Recovery ◽  
Clinical Symptoms ◽  
Lateral Epicondylitis ◽  
High Rate ◽  
Evidence Based ◽  
Physical Methods ◽  
Local Injections ◽  
One Year ◽  
Golfer’S Elbow ◽  
Non Surgical Treatment

“Tennis and golfer’s elbow” are common pathologies due to overload of forearm extensors and flexors, and actually occur mostly outside tennis and golf sports. Several differential diagnoses of medial and lateral epicondylitis have to be excluded as there are a number of other conditions with similar clinical symptoms. The high rate of spontaneous recovery has to be considered in treatment. Evidence based conservative treatment comprises excentric physiotherapy, local injections, and physical methods. Surgery is reserved for patients with persistence of symptoms for more than one year despite non-surgical treatment.

scholarly journals Implementation of NAVIGATE Coordinated Specialty Care for First Episode Psychosis: the Michigan Experience

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 177-178
Author(s):  
Eric D. Achtyes ◽  
Kari Kempema ◽  
Zhehui Luo ◽  
Katharine N. Thakkar ◽  
Catherine Adams ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Symptoms ◽  
The United States ◽  
First Episode Psychosis ◽  
Specialty Care ◽  
First Episode ◽  
Control Group ◽  
Evidence Based ◽  
Block Grant ◽  
Episode Psychosis

AbstractStudy ObjectivesCoordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.MethodsIn 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.ResultsN=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.ConclusionThe implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.FundingSupported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.

scholarly journals Role of Invasive Urodynamic Studies in Establishing Cauda Equina Syndrome and Postoperative Recovery

2020 ◽  
pp. 219256822097964
Author(s):  
Abhinandan Reddy Mallepally ◽  
Bibhudendu Mohapatra ◽  
Kalidutta Das
Keyword(s):  
Clinical Symptoms ◽  
False Positive Rate ◽  
Cauda Equina ◽  
Postoperative Recovery ◽  
Normal Bladder ◽  
Acontractile Detrusor ◽  
Positive Rate ◽  
Acute Radiculopathy ◽  
Operative Recovery

Study design: Retrospective with prospective follow-up. Objective: Confirming the diagnosis of CES based purely on symptoms and signs is unreliable and usually associated with high false positive rate. A missed diagnosis can permanently disable the patient. Present study aims to determine the relationship between clinical symptoms/ signs (bladder dysfunction) with UDS, subsequently aid in surgical decision making and assessing post-operative recovery. Methods: A prospective follow-up of patients with disc herniation and bladder symptoms from January 2018 to July 2020 was done. All patients underwent UDS and grouped into acontractile, hypocontractile and normal bladder. Data regarding PAS, VAC, GTP, timing to surgery and onset of radiculopathy and recovery with correlation to UDS was done preoperatively and post operatively. Results: 107 patients were studied (M-63/F-44). Patients with PAS present still had acontractile (61%) or hypocontractile (39%) detrusor and with VAC present, 57% had acontractile and 43% hypocontractile detrusors. 10 patients with both PAS and VAC present had acontractile detrusor. 82% patients with acute radiculopathy (<2 days) improved when operated <24 hrs while only 47% showed improvement with chronic radiculopathy. The detrusor function recovered in 66.1% when operated <12 hours, 40% in <12-24 hours of presentation. Conclusion: Adjuvant information from UDS in combination with clinicoradiological findings help in accurate diagnosis even in patients with no objective motor and sensory deficits. Quantitative findings on UDS are consistent with postoperative recovery of patient’s urination power, representing improvement and can be used as a prognostic factor.

A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process

2011 ◽  
Vol 34 (2) ◽  
pp. 98-106 ◽  
Author(s):  
Ian Paskowski ◽  
Michael Schneider ◽  
Joel Stevans ◽  
John M. Ventura ◽  
Brian D. Justice
Keyword(s):  
Care Pathway ◽  
Evidence Based ◽  
Spine Care
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