P-OGC13 Chest drainage after oesophageal resection: A systematic review

Abstract Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300ml did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusions Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.

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Chest drainage after oesophageal resection: A systematic review

Diseases of the Esophagus ◽

10.1093/dote/doab069 ◽

2021 ◽

Author(s):

Alexander Bull ◽

Philip H Pucher ◽

Jesper Lagergren ◽

James A Gossage

Keyword(s):

Enhanced Recovery ◽

Cochrane Collaboration ◽

Patient Comfort ◽

Drain Removal ◽

Thoracic Drainage ◽

Position Type ◽

Oesophageal Surgery ◽

Negative Impacts ◽

Recovery Protocols ◽

The Impact

Summary Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300 mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusion Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.

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714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW

Diseases of the Esophagus ◽

10.1093/dote/doab052.714 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Charles Bull ◽

Philip H Pucher ◽

James Gossage

Keyword(s):

Enhanced Recovery ◽

Cochrane Collaboration ◽

Patient Comfort ◽

Effusion Rate ◽

Thoracic Drainage ◽

Drain Fluid ◽

Position Type ◽

Oesophageal Surgery ◽

Recovery Protocols

Abstract The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores. Results 28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis. Conclusion Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study (Preprint)

10.2196/preprints.26597 ◽

2020 ◽

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

BACKGROUND Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. OBJECTIVE The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. METHODS Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. RESULTS The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. CONCLUSIONS Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study

JMIR Perioperative Medicine ◽

10.2196/26597 ◽

2021 ◽

Vol 4 (2) ◽

pp. e26597

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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FAKTOR DETERMINAN PENYALURAN KREDIT BANK PERSERO

Journal of Business Economics ◽

10.35760/eb.2018.v23i1.1812 ◽

2018 ◽

Vol 23 (1) ◽

pp. 60-71

Author(s):

Wigiyanti Masodah

Keyword(s):

Interest Rate ◽

Linear Regression ◽

Interest Rates ◽

Regression Models ◽

Linear Regression Models ◽

Negative Impacts ◽

Main Activity ◽

The Impact ◽

The Given ◽

Multiple Linear Regression Models

Offering credit is the main activity of a Bank. There are some considerations when a bank offers credit, that includes Interest Rates, Inflation, and NPL. This study aims to find out the impact of Variable Interest Rates, Inflation variables and NPL variables on credit disbursed. The object in this study is state-owned banks. The method of analysis in this study uses multiple linear regression models. The results of the study have shown that Interest Rates and NPL gave some negative impacts on the given credit. Meanwhile, Inflation variable does not have a significant effect on credit given. Keywords: Interest Rate, Inflation, NPL, offered Credit.

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The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2017.10.151 ◽

2018 ◽

Vol 155 (4) ◽

pp. 1843-1852 ◽

Cited By ~ 38

Author(s):

Luke J. Rogers ◽

David Bleetman ◽

David E. Messenger ◽

Natasha A. Joshi ◽

Lesley Wood ◽

...

Keyword(s):

Lung Cancer ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Primary Lung Cancer ◽

Protocol Compliance ◽

Eras Protocol ◽

The Impact

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Advanced Greenhouse Horticulture: New Technologies and Cultivation Practices

Horticulturae ◽

10.3390/horticulturae7010001 ◽

2020 ◽

Vol 7 (1) ◽

pp. 1

Author(s):

Athanasios Koukounaras

Keyword(s):

New Technologies ◽

Light Emitting Diode ◽

Dye Sensitized Solar Cells ◽

Original Research ◽

Brewery Wastewater ◽

Cultivation Practices ◽

Substrate Properties ◽

Greenhouse Horticulture ◽

Negative Impacts ◽

The Impact

Greenhouse horticulture is one of the most intensive agricultural systems, with the advantages of environmental parameter control (temperature, light, etc.), higher efficiency of resource utilization (water, fertilizers, etc.) and the use of advanced technologies (hydroponics, automation, etc.) for higher productivity, earliness, stability of production and better quality. On the other hand, climate change and the application of high inputs without suitable management could have negative impacts on the expansion of the greenhouse horticulture sector. This special issue gathers twelve papers: three reviews and nine of original research. There is one review that focuses on irrigation of greenhouse crops, while a second surveys the effects of biochar on container substrate properties and plant growth. A third review examines the impact of light quality on plant–microbe interactions, especially non-phototrophic organisms. The research papers report both the use of new technologies as well as advanced cultivation practices. In particular, new technologies are presented such as dye-sensitized solar cells for the glass cover of a greenhouse, automation for water and nitrogen deficit stress detection in soilless tomato crops based on spectral indices, light-emitting diode (LED) lighting and gibberellic acid supplementation on potted ornamentals, the integration of brewery wastewater treatment through anaerobic digestion with substrate-based soilless agriculture, and application of diatomaceous earth as a silica supplement on potted ornamentals. Research studies about cultivation practices are presented comparing different systems (organic-conventional, aeroponic-nutrient film technique (NFT)-substrate culture), quantitative criteria for determining the quality of grafted seedlings, and of wild species as alternative crops for cultivation.

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Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

Journal of Surgical Research ◽

10.1016/j.jss.2021.01.050 ◽

2021 ◽

Vol 266 ◽

pp. 54-61

Author(s):

Jessica Y Liu ◽

Sebastian D Perez ◽

Glen G Balch ◽

Patrick S Sullivan ◽

Jahnavi K Srinivasan ◽

...

Keyword(s):

Colorectal Surgery ◽

Elderly Patients ◽

Enhanced Recovery ◽

Recovery Protocols

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The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01399-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiyu Geng ◽

Hui Bi ◽

Dai Zhang ◽

Changji Xiao ◽

Han Song ◽

...

Keyword(s):

Enhanced Recovery ◽

Controlled Trial ◽

Bowel Function ◽

Multimodal Analgesia ◽

Study Group ◽

Gynecological Surgery ◽

Quality Of Recovery ◽

Enhanced Recovery Protocol ◽

The Impact

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

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Inequality, policy polarization and the income gap in turnout

Party Politics ◽

10.1177/13540688211011924 ◽

2021 ◽

pp. 135406882110119

Author(s):

Matthew Polacko

Keyword(s):

Income Inequality ◽

Low Income ◽

Party Systems ◽

Individual Level ◽

Income Gap ◽

Income Groups ◽

Logistic Regressions ◽

Negative Impacts ◽

The Impact ◽

The Relationship

Previous research into the relationship between income inequality and turnout inequality has produced mixed results, as consensus is lacking whether inequality reduces turnout for all income groups, low-income earners, or no one. Therefore, this paper builds on this literature by introducing supply-side logic, through the first individual-level test of the impact that income inequality (moderated by policy manifesto positions) has on turnout. It does so through multilevel logistic regressions utilizing mixed effects, on a sample of 30 advanced democracies in 102 elections from 1996 to 2016. It finds that higher levels of income inequality significantly reduce turnout and widen the turnout gap between rich and poor. However, it also finds that when party systems are more polarized, low-income earners are mobilized the greatest extent coupled with higher inequality, resulting in a significantly reduced income gap in turnout. The findings magnify the negative impacts income inequality can exert on political behavior and contribute to the study of policy offerings as a key moderating mechanism in the relationship.

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