scholarly journals Longitudinal patient-reported outcomes and restrictive opioid prescribing after minimally invasive gynecologic surgery

2020 ◽  
Vol 31 (1) ◽  
pp. 114-121
Author(s):  
R. Tyler Hillman ◽  
Maria D Iniesta ◽  
Qiuling Shi ◽  
Tina Suki ◽  
Tsun Chen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Statistical Significance ◽  
Symptom Burden ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Opioid Prescribing ◽  
Median Reduction ◽  
Significant Difference ◽  
Patient Reported ◽  
Before And After

ObjectiveTo determine post-discharge patient-reported symptoms before and after implementation of restrictive opioid prescribing among women undergoing minimally invasive gynecologic surgery.MethodsWe compared clinical outcomes and symptom burden among a cohort of 389 women undergoing minimally invasive gynecologic surgery at a single institution before and after implementation of a restrictive opioid prescribing quality improvement initiative in July 2018. Post-discharge symptom burdens were collected up to 42 days after discharge using the MD Anderson Symptom Inventory and analyzed using linear mixed effects models.ResultsThe majority of women included in this study were white non-smokers and the median age was 55 (range 23–83). Most women underwent hysterectomy (64%), had surgery for malignancy (71%), and were discharged from the hospital on the day of surgery (65%). Women in the restrictive opioid prescribing group had a median reduction in morphine equivalent dose prescribed at discharge of 83%, corresponding to a median reduction in 25 tablets of 5 mg oxycodone per person. There was no difference between opioid prescribing groups in either the rate of refill requests (P=1) or hospital re-admission (P=1) up to 30 days after discharge. After adjustment for co-variates, there was no statistically significant difference in post-discharge symptom burden including patient-reported pain (P=0.08), sleep (P=0.30), walking interference (P=0.64), activity interference (P=0.12), or affective interference (P=0.67). There was a trend toward less reported constiptation in the restrictive opioid prescribing group that did not reach statistical significance (P=0.05).ConclusionWe found that restrictive post-operative opioid prescribing was not associated with differences in longitudinal symptom burden among women undergoing minimally invasive gynecologic surgery. These results provide the most comprehensive picture to date of post-operative symptom recovery under different opioid prescribing approaches, lending additional support for existing recommendations to reduce opioid prescribing following gynecologic surgery.

Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery

2021 ◽  
pp. ijgc-2021-002674
Author(s):  
Sarah Huepenbecker ◽  
Robert Tyler Hillman ◽  
Maria D Iniesta ◽  
Tsun Chen ◽  
Katherine Cain ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Symptom Burden ◽  
Equivalent Dose ◽  
Hospital Length Of Stay ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Opioid Prescribing ◽  
Patient Reported ◽  
Morphine Equivalent

ObjectiveTo compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.MethodsWe compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.ResultsAmong 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.ConclusionsAfter implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.

Recovery of symptom burden and functioning for patients with late discharge after an open surgery for GYN tumors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18083-e18083
Author(s):  
Charles S. Cleeland ◽  
Qiuling Shi ◽  
Larissa Meyer ◽  
Ting-Yu Chen ◽  
Araceli Garcia-Gonzalez ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Physical Functioning ◽  
Open Surgery ◽  
Symptom Burden ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Patient Reported ◽  
Discharged Patients ◽  
Delayed Recovery ◽  
Md Anderson

e18083 Background: The symptom burden and functional recovery of patients after hospital discharge is important to understand in order to provide more patient centered care. This study evaluated longitudinal quantitative patient-reported outcome (PRO) data using a validated PRO symptom and functional interference measure after hospital discharge from open gynecologic surgery. Methods: Patients with GYN tumors scheduled for laparotomy at MD Anderson Cancer Center were recruited prospectively. The MD Anderson Symptom Inventory gynecology perioperative care module (MDASI-PeriOp-GYN) was used to assess symptoms post discharge on Day 3, 7, and weekly up to 6 weeks. Median survival time and log-rank test was used for comparing time to return to no or mild level (≤3 in a 0-10 scale) of symptoms during the post discharge period between groups who discharged within and beyond the median length of stay (LOS) days. Results: From Feb 2018–Dec 2018, 83 patients were evaluable. The median LOS was 3 days. Compared to patients who were discharged within 3 days (70% of sample), 30% patients were discharged after 3 days after surgery (range of 4-10 days). Except distress, all other PROs on MDASI-PeriOp-GYN were not significantly different between the two groups on the day of discharge. However, those late discharged patients had significantly delayed recovery on fatigue (median recovery time > 56 days vs. 17 days), dry mouth (10 days vs. 6 days) (both P< .01), and drowsiness (12 days vs. 6 days, P< .05). The recovery of physical functioning (MDASI general activity interference item) was prolonged among late discharged patients compared to patients who were discharge within 3 days ( > 56 days vs. 30 days, P< .01). Conclusions: Even though all patients were under a standardized Enhanced Recovery Program, about 30% of patients post GYN open surgery were discharged beyond the median LOS. Patients in this group continued to have delayed recovery after hospital discharge as evidenced by persistent fatigue and slower return of physical functioning. Implementation of post-discharge PROs may help identify patients at risk for prolonged recovery and help triage patients to more intensive supportive care.

STUDY CLINICAL FEATURE AND RESULT OF TREATMENT PHACOMORPHIC GLAUCOMA

2015 ◽  
pp. 71-75
Author(s):  
Van Nam Phan ◽  
Ba Ken Tran
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Statistical Significance ◽  
Corneal Edema ◽  
Clinical Feature ◽  
Anterior Chamber Angle ◽  
Male Population ◽  
Significant Difference ◽  
Operative Complications ◽  
Before And After

Purpose: Study clinical feature of phacomorphic glaucoma. To evaluate the result of treatment phacomorphic glaucoma. Method: The retrospective, interventional study on 36 cases with phacomorphic glaucoma who underwent treated at Hue Central Hospital from 6/2010 to 6/2011. Standard of research: visual, IOP, before and after surgery, accompanying lesions and post-operative complications. The surgery is considered successful when postoperative IOP less than 21 mmHg. Results: Age 50-59 presented 30.5 percent, ≥ 60 presented 91.7 percent. There was a slight female preponderance (66.7%) compared to the male population (33.3%) which implies a statistically marginally significant difference. However there was no statistical significance difference when compared by the two subgroups. Patient in country presented 61,1% and city presented 38,9%. The duration between the onset of pain and surgery from 0 to < 5 days (77.8%), from 6 to 10 (16.7%) and >10 days presented 5.5%. The preoperative intraocular pressure 35 to 45mmHg (47.2%), 46-55 (30.6%), 56-65 (13.9%) and more than 65 presented 8.3%. The visual acuity preoperation less than 1metre count finger (94.5%), less than 3 metre count finger presented 5.5%. Close anterior chamber angle presented 80.6% and shallow was presented 19.4%. Corneal edema presented 100%, iritis presented 94.4%, dilated pupil larger 5mm presented 83.3%, Synchynea iris and cataract presented 72.2%. ECCE, implantation IOL combined trabeculectomy presented 11.1%, Phaco, implantation IOL combined trabeculectomy presented 69,5%, ECCE implantation IOL presented 5.6%, Phaco, implantation IOL presented 13.8%. Postoperative visual acuity from 1/10 to 5/10 presented 72.2%, no case have VA larger than 5/10. Postoperative 3 months VA 1/10 to 5/10 presented 72.2%, larger VA 5/10 presented 8.3%. Postoperative 3 months intraocular pressure ≤ 21mmHg presented 91.7%, 22 to 24mmHg presented 8.3%, no case have IOP ≥25mmHg. Postoperative edema presented 58.3%, iritis presented 58.3%. Key words: phacomorphic Glaucoma

State Recreational Marijuana Laws and Dispensaries: Chronic School Absenteeism in Washington State

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Maxim Gakh ◽  
Courtney Coughenour ◽  
Brooke Kleven ◽  
Brian Labus
Keyword(s):  
Social Factors ◽  
Statistical Significance ◽  
Secondary Analysis ◽  
Risk Groups ◽  
Washington State ◽  
School Absenteeism ◽  
Chronic Absenteeism ◽  
Significant Difference ◽  
Before And After ◽  
Recreational Marijuana

Objective: Whereas states continue to experiment with liberalized marijuana laws, how these laws impact health, education, and social factors is not yet fully understood. In this study, we examined whether chronic school absenteeism rates changed in Washington State in the presence of recreational marijuana dispensaries pursuant to implementation of the state’s recreational marijuana laws. Methods: We conducted a secondary analysis using school district chronic absenteeism rates before and after the presence of recreational dispensaries. Results: The results of the independent samples t-test showed no statistically significant difference in chronic absenteeism rates among districts with or without recreational marijuana dispensaries. Conclusions: The finding of no statistical significance for chronic absenteeism in districts with and without recreational dispensaries – a pattern that largely persisted among at-risk groups – supports that the presence of recreational marijuana dispensaries seems neither to exacerbate nor improve chronic school absenteeism rates. This finding is important for policymakers, practitioners, and researchers trying to understand the changing marijuana legal landscape.

scholarly journals The Effects of Patients' and Care-Givers' Knowledge, Attitude, & Practice (KAP) on Quality of Life Among Thalassemia Major Patients' in Damascus-Syrian Arab Republic

2018 ◽  
Vol 14 (12) ◽  
pp. 308
Author(s):  
Yaser Adnan Abo Jeesh ◽  
Magda El-hadi Ahmad Yousif ◽  
Moauya Al-Balal Al-Haboub
Keyword(s):  
Quality Of Life ◽  
Statistical Significance ◽  
Thalassemia Major ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Teaching Guide ◽  
Care Givers ◽  
Significant Difference ◽  
Before And After

Background: Thalassemia is the most common autosomal abnormality in Syria. Its complications have an important effect on education; time off school; sport; difference from friends/ siblings; social interactions; and stigmatization. Knowledge of factors associated with quality of life in thalassemia patients is necessary for forming appropriate clinical programs, social support, and improving treatment outcomes. Purpose: The study was to assess the effects of Patients' and Care-givers' Knowledge, Attitude, & Practice (KAP) with Quality of Life among Thalassemia Major Patients' in Syria. Methods: Cross-sectional descriptive analytical design was conducted at the national thalassemia center in Damascus. WHOQOL-BREF and a questionnaire developed by the researcher were used to measure the participants’ knowledge, attitudes and practices of thalassemia. Results: Total of 238 thalassemia patients participated in the study. A statistical significance was found regarding improvement of skill and knowledge scores among caregivers and thalassemia patients before and after receiving the teaching guide from 12.52±1.77 to 14.07±1.01, t=11.447, p=0.000 and from 34.12±4.50 to 37.43±4.61, t=-8.58, p= .000 respectively. Stigmatization was significantly noticed among families caring for thalassemic patients. There were a significant differences in the mean score regarding nutritional status before and after teaching guide paired t test= 12.11, p= 0.000. A statistical significance was found in females regarding social domain p=0.04. However, mean scores for overall quality of life were better in females rather than males, but these mean scores were statistically insignificant p>0.05. A statistical significant difference in ferritin levels and patient’s age was found. Results also revealed that no statistical significant differences was observed between overall quality of life of the four domains in relation to the two treatment groups (subcutaneous vs oral) and age groups. Conclusion: Thalassemia is a socio-economic problem. The most efficient way to reduce risks of having affected patients is by increasing the knowledge through training of parents regarding the disease. Our findings highlighted that there was lack in patients’ knowledge and skills regarding the disease, but a remarkable improvement in both knowledge and performance was found after patients received the teaching guide, which lead to an increase in overall patient's quality of life.

scholarly journals SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Elkadi ◽  
Eleanor Dodd ◽  
Theodore Poulton ◽  
William Bolton ◽  
Joshua Burke ◽  
...  
Keyword(s):  
Wound Healing ◽  
Local Anaesthetic ◽  
Surrogate Endpoints ◽  
Incision And Drainage ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Before And After ◽  
The Impact

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p &lt; 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

scholarly journals Cytotoxicity of three-dimensional paper-based models from a three-dimensional paper-based printer

NEMESIS ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 15 ◽  
Author(s):  
Marcin Kozakiewicz ◽  
Piotr Szymor ◽  
Raphael Olszewski
Keyword(s):  
Operating Room ◽  
Dermal Fibroblast ◽  
Statistical Significance ◽  
Three Dimensional ◽  
Dermal Fibroblasts ◽  
Tissue Adhesive ◽  
Biological Behaviour ◽  
Sterilization Method ◽  
Significant Difference ◽  
Before And After

Objective: Our study aimed to determine the possibility of using models created with a low-cost, paper based 3D printer in an operating room. Therefore influence of different methods of sterilization on models was tested and cytotoxicity of generated models was determined. Material and methods: 30 cuboids divided into three groups were used for verification of shape stability after sterilization. Each group was sterilized either with: Ethylene oxide in temperature 55˚C, Hydrogen peroxide gas plasma in temperature 60˚C or Gamma irradiation at 21˚C, 25kGy. Each cuboid was measured using calliper three times before and three times after sterilization. Results were analysed statistically in Statgraphics Plus. Statistical significance was determined as p< 0.05. Sixty cylinders divided into six groups were used for cytotoxicity tests. Three of those groups were covered before sterilization with 2-octyl-cyanoacrylate. Each group was sterilized with one of the previously described methods. Cytotoxicity was tested by Nanostructural and Molecular Biophysics Laboratory in Technopark Lodz using normal adult human dermal fibroblasts. Survival of cells was tested using spectrophotometry with XTT and was defined as ratio of absorbency of tested probe to absorbency of control probe. Calcein/Ethidium dyeing test was performed according to LIVE/DEAD Viability/Cytotoxicity Kit protocol. Observation was done under Olympus GX71 fluorescence microscope. Results: There was no statistically significant difference for established statistical significance p=0.05 in cuboids dimensions before and after sterilization regardless of sterilization method. In XTT analysis all samples showed higher cytotoxicity against normal, human, adult dermal fibroblast culture when compared to positive control. ANOVA statistical analysis confirmed that 2-octyl cyanoacrylate coating of paper model improved biological behaviour of the material. It decreased cytotoxicity of the model independently of sterilization method. In calcein/ethidium dyeing test due to the high fluorescence of the background caused by cylinders of analysed substance it was impossible to perform the exact analysis of the number of marked cells. Conclusions: Acquired results allow to conclude that Mcor Technology Matrix 300 3D paper-based models can be used in operating room only if covered with cyanoacrylate tissue adhesive. Nemesis relevance: We found no statistically significant difference in cuboids dimensions before and after sterilization regardless of sterilization method. Three-dimensional paper-based models present with high cytotoxicity without coating.

Abstract 11: Comparison of Patient Reported Angina with Provider Assigned Canadian Cardiovascular Society Angina Class Before and After Revascularization

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Michael E Nassif ◽  
David J Cohen ◽  
Suzanne V Arnold ◽  
Mohammed Qintar ◽  
Michael E Farkouh ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Symptom Burden ◽  
Canadian Cardiovascular Society ◽  
Chi Square ◽  
Critical Determinant ◽  
Patient Reported ◽  
Before And After ◽  
Angina Frequency ◽  
Using Data

Background: The Canadian Cardiovascular Society (CCS) classification system for angina is a critical determinant of revascularization appropriateness. A major limitation of CCS is that it rates patients’ symptoms from the perspective of providers, rather than patients themselves. Accordingly, we sought to evaluate the correlation of physician-assigned CCS class with patient-reported Seattle Angina Questionnaire (SAQ), before and after revascularization. Methods: Using data from the FREEDOM trial, which randomized 1900 patients from over 160 international sites to either PCI or CABG, CCS was reported by physicians and the SAQ was completed by patients prior to randomization and 1 year later. SAQ angina frequency (SAQ AF) scores were considered to correspond to CCS class per the following: SAF AF: 100=CCS 0, 61-99=CCS I, 31-60=CCS II, 0-30=CCS III/IV. Agreement between physician- and patient-reported angina categories was compared using chi square tests. Results: Among 1640 patients who had CCS and SAQ data at both baseline and 1-year, the mean age was 63.1 years, 71% were male, and 83% had 3-vessel coronary disease. Before revascularization, physicians correctly reported the burden of angina in 25.5% of patients and overestimated the burden of angina in 62.1%. Among 1194 patients who reported monthly or no angina, 229 (19.2%) were classified by their physicians as having CCS III/IV. In contrast, at follow-up, 71.2% of patients had their angina correctly estimated by their physicians and only 0.6% among the 1568 patients with monthly/no angina were assigned CCS III/IV by their physicians. Among the 28.8% misclassified by CCS at 1 year, 20.8% had less angina than reported by physicians and 8.0% had more (Figure; p=0.01). Findings were similar when the analysis was repeated in patients who were treated with PCI or CABG. Conclusions: In a large cohort of patients with stable coronary disease undergoing revascularization, clinicians often overestimated the amount of angina patients were having prior to revascularization but were significantly more accurate at follow-up. Given that importance placed on CCS for enrollment in clinical trials, or assigning appropriateness of revascularization in clinical practice, using patient-reported symptom burden as a more unbiased measure should be considered.

Sign in / Sign up

Export Citation Format

Share Document