scholarly journals Types of surgical patients enrolled in enhanced recovery after surgery (ERAS) programs in the USA

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sunitha M. Singh ◽  
Asha Liverpool ◽  
Jamie L. Romeiser ◽  
Julie Thacker ◽  
Tong J. Gan ◽  
...  
Keyword(s):  
San Francisco ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Positive Association ◽  
Surgical Oncology ◽  
Surgical Service ◽  
Significant Positive Association ◽  
The Usa ◽  
Surgery Residency Program

Abstract Background Enhanced Recovery After Surgery (ERAS) programs have gained traction across US hospitals in the past two decades. Initially implemented for elective colorectal surgical procedures, ERAS has expanded to a variety of surgical service lines. There is little information regarding the extent to which various surgical service lines use ERAS. Methods A survey was performed to describe the prevalence of ERAS programs across surgical service lines in the USA. The survey had questions regarding the number of ERAS programs, operating rooms (ORs) and presence of anesthesia and/or surgery residency program at an institution. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 88 unique institutions. The most commonly reported surgical service lines were colorectal (87%), gynecology (51%), orthopedic (49%), surgical oncology (39%), and urology (35%). A significant positive association was observed between the number of ORs and the number ERAS programs (Spearman’s Rho 0.5, p<0.0001). Furthermore, institutions that reported an anesthesia and/or surgery residency program had more ERAS programs (mean 5.0 ± 3.2) compared to those that did not (mean 2.0 ± 2.0) (Wilcoxon rank sum p< 0.001). Conclusions ERAS has expanded to a large extent outside of the colorectal surgery service line with increases notable in orthopedic surgery, obstetric/gynecology, surgical oncology, and urology procedures. Institutions with a higher number of ORs and the presence of an anesthesia and/or surgery residency program are associated with an increased number of ERAS programs.

scholarly journals Implementing ERAS: how we achieved success within an anesthesia department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dan B. Ellis ◽  
Aalok Agarwala ◽  
Elena Cavallo ◽  
Pam Linov ◽  
Michael K. Hidrue ◽  
...  
Keyword(s):  
General Hospital ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Massachusetts General Hospital ◽  
Educational Interventions ◽  
Nurse Anesthetists ◽  
Intervention Period ◽  
Post Intervention ◽  
Anesthesia Group

Abstract Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions. Conclusions Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

Association between air travel and importation of chikungunya into the USA

2019 ◽  
Vol 26 (5) ◽  
Author(s):  
Tahmina Nasserie ◽  
Shannon E Brent ◽  
Ashleigh R Tuite ◽  
Rahim Moineddin ◽  
Jean H E Yong ◽  
...  
Keyword(s):  
Negative Binomial ◽  
State Level ◽  
Positive Association ◽  
Air Travel ◽  
The State ◽  
Significant Positive Association ◽  
Increased Risk ◽  
Epidemic Period ◽  
Imported Cases ◽  
The Usa

Abstract Background: During infectious disease outbreaks with pandemic potential, the number of air passengers travelling from the outbreak source to international destinations has been used as a proxy for disease importation risk to new locations. However, evaluations of the validity of this approach are limited. We sought to quantify the association between international air travel and disease importation using the 2014–2016 chikungunya outbreak in the Americas as a case study. Methods: We used country-level chikungunya case data to define a time period of epidemic activity for each of the 45 countries and territories in the Americas reporting outbreaks between 2014 and 2016. For each country, we identified airports within or proximate to areas considered suitable for chikungunya transmission and summed the number of commercial air passengers departing from these airports during the epidemic period to each US state. We used negative binomial models to quantify the association between the number of incoming air passengers from countries experiencing chikungunya epidemics and the annual rate of chikungunya importation into the USA at the state level. Results: We found a statistically significant positive association between passenger flows via airline travel from countries experiencing chikungunya epidemics and the number of imported cases in the USA at the state level (P < 0.0001). Additionally, we found that as the number of arriving airline passengers increased by 10%, the estimated number of imported cases increased by 5.2% (95% CI: 3.0–7.6). Conclusion: This validation study demonstrated that air travel was strongly associated with observed importation of chikungunya cases in the USA and can be a useful proxy for identifying areas at increased risk for disease importation. This approach may be useful for understanding exportation risk of other arboviruses.

Adherence to Enhanced Recovery after Surgery Protocols across a High-Volume Gastrointestinal Surgical Service

2014 ◽  
Vol 31 (2) ◽  
pp. 117-122 ◽  
Author(s):  
John S. Hammond ◽  
Sarah Humphries ◽  
Nick Simson ◽  
Helen Scrimshaw ◽  
James Catton ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
High Volume ◽  
Surgical Service

Enhanced Recovery After Surgery (ERAS®) in thoracic surgical oncology

2018 ◽  
Vol 14 (6s) ◽  
pp. 33-40 ◽  
Author(s):  
Alessandro Gonfiotti ◽  
Domenico Viggiano ◽  
Stefano Bongiolatti ◽  
Luca Bertolaccini ◽  
Piergiorgio Solli ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Oncology

scholarly journals Enhanced Recovery After Surgery (ERAS) Protocol for Gastrectomy: A Tailored Program Developed at a Gastric Cancer Unit

2020 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Jacopo Desiderio ◽  
Stefano Trastulli ◽  
Antonio Di Cintio ◽  
Rita Commissari ◽  
Andrea Colasanti ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Care Management ◽  
Enhanced Recovery ◽  
Patient Adherence ◽  
Enhanced Recovery After Surgery ◽  
Surgical Oncology ◽  
Evidence Based ◽  
Care Environment ◽  
Comprehensive Management ◽  
Eras Protocol

Background Planning for and managing patients who follow multidisciplinary paths allow institutions to provide better care administration; greater collaboration among medical staff, patients, and their relatives; better patients education; reduced possible complications related to surgery and hospital stay; and increased patient adherence to the proposed treatments due to better information. The ERAS Society’s guidelines align in this direction, and many institutions are now looking to apply the suggestions contained in its items. This effort is especially important in surgical oncology. In this work, we report the experience of our center in developing tailored guidelines for patients undergoing gastrectomy based on evidence from the literature and adapted to address the availability of personnel and equipment in our institute. Methods A permanent institutional working group was established at St. Mary’s Hospital. Evidence‐based comprehensive research was conducted to find optimal perioperative care management for patients undergoing gastrectomy. Evidence and recommendations were thoroughly evaluated and considered together with the items from the ERAS Society’s guidelines. Results A complete patient pathway has been established from the first outpatient visit to discharge. All ERAS items were considered and adapted to our hospital’s care environment. Education, nutrition, anesthesiologist care, surgical approach, and ward organization are the main points of strength highlighted in the present work. Conclusion This proposed institutional evidence‐based protocol show comprehensive management for patients with gastric cancer eligible for enhanced surgical pathways.

scholarly journals Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females

2013 ◽  
Vol 118 (3) ◽  
pp. 649-656 ◽  
Author(s):  
Elizabeth B. Claus ◽  
Lisa Calvocoressi ◽  
Melissa L. Bondy ◽  
Margaret Wrensch ◽  
Joseph L. Wiemels ◽  
...  
Keyword(s):  
Body Mass Index ◽  
San Francisco ◽  
Body Mass ◽  
Hormone Replacement ◽  
Premenopausal Women ◽  
Positive Association ◽  
Age At Menarche ◽  
Intracranial Meningioma ◽  
Significant Positive Association ◽  
Increased Risk

Object The 2-fold higher incidence of meningioma in women compared with men has long suggested a role for hormonally mediated risk factors, but specific mechanisms remain elusive. Methods The study included data obtained in 1127 women 29–79 years of age with intracranial meningioma diagnosed among residents of Connecticut, Massachusetts, North Carolina, the San Francisco Bay Area, and 8 Texas counties between May 1, 2006, and October 6, 2011, and data obtained in 1092 control individuals who were frequency matched for age group and geography with meningioma patients. Results No association was observed for age at menarche, age at menopause, or parity and meningioma risk. Women who reported breastfeeding for at least 6 months were at reduced risk of meningioma (OR 0.78, 95% CI 0.63–0.96). A significant positive association existed between meningioma risk and increased body mass index (p < 0.01) while a significant negative association existed between meningioma risk and current smoking (p < 0.01). Among premenopausal women, current use of oral contraceptives was associated with an increased risk of meningiomas (OR 1.8, 95% CI 1.1–2.9), while current use of hormone replacement therapy among postmenopausal women was not associated with a significant elevation in risk (OR 1.1, 95% CI 0.74–1.67). There was no association between use of fertility medications and meningioma risk. Conclusions The authors' study confirms associations for body mass index, breastfeeding, and cigarette smoking but provides little evidence for associations of reproductive and menstrual factors with meningioma risk. The relationship between current use of exogenous hormones and meningioma remains unclear, limited by the small numbers of patients currently on oral hormone medications and a lack of hormone receptor data for meningioma tumors.

scholarly journals A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sunitha M. Singh ◽  
Asha Liverpool ◽  
Jamie L. Romeiser ◽  
Joshua D. Miller ◽  
Julie Thacker ◽  
...  
Keyword(s):  
San Francisco ◽  
National Survey ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Complex Carbohydrate ◽  
Patients With Diabetes ◽  
American Society ◽  
Simple Carbohydrate ◽  
Diabetes Patients

Abstract Background Carbohydrate-containing drinks (CCD) are administered preoperatively in most enhanced recovery after surgery (ERAS) programs. It is not known which types of CCDs are used, e.g., simple vs. complex carbohydrate, and if the choice of drink differs in patients with diabetes. Methods A national survey was performed to characterize the use of preoperative CCDs within the context of adult colorectal ERAS programs. The survey had questions regarding the use of preoperative CCDs, the types of beverages used, and the timing of beverage administration. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 78 unique hospitals with a colorectal ERAS program of which 68 (87.2%) reported administering a preoperative drink. Of these, 98.5%, 80.9%, and 60.3% of hospitals administered a beverage to patients without diabetes, patients with diabetes not taking insulin, and patients with diabetes taking insulin, respectively. Surprisingly, one third of programs that administered a beverage to patients with diabetes used a simple carbohydrate drink. Conclusions This survey finds a high use of CHO-containing beverages in colorectal ERAS programs. More than half of all programs administer a CHO-containing beverage to patients with diabetes, and surprisingly, there is significant use of simple carbohydrate beverages in patients with diabetes receiving insulin.

Perceived Overprotection and Its Association With Quality of Life in Dementia

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 125-134
Author(s):  
Mechthild Niemann-Mirmehdi ◽  
Andreas Häusler ◽  
Paul Gellert ◽  
Johanna Nordheim
Keyword(s):  
Quality Of Life ◽  
Patient Autonomy ◽  
Positive Association ◽  
Well Being ◽  
Negative Association ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
People With Dementia ◽  
Mental Well Being

Abstract. To date, few studies have focused on perceived overprotection from the perspective of people with dementia (PwD). In the present examination, the association of perceived overprotection in PwD is examined as an autonomy-restricting factor and thus negative for their mental well-being. Cross-sectional data from the prospective DYADEM study of 82 patient/partner dyads (mean age = 74.26) were used to investigate the association between overprotection, perceived stress, depression, and quality of life (QoL). The analyses show that an overprotective contact style with PwD has a significant positive association with stress and depression, and has a negative association with QoL. The results emphasize the importance of avoiding an overprotective care style and supporting patient autonomy.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

The Nexus Between Urbanisation and Human Empowerment: Income Group Based Findings of Bidirectional Causality

2019 ◽  
Vol 64 (1) ◽  
pp. 5-15
Author(s):  
Christos Kollias ◽  
Panayiotis Tzeremes
Keyword(s):  
Human Rights ◽  
Positive Association ◽  
Income Group ◽  
Academic Discourse ◽  
Access To Education ◽  
Democratic Institutions ◽  
Significant Positive Association ◽  
Public Action ◽  
Income Groups ◽  
Democratic Rule

Abstract The economic and social drivers of democratisation and the emergence and establishment of democratic institutions are longstanding themes of academic discourse. Within this broad body of literature, it has been argued that the process of urbanisation is also conducive to the emergence and consolidation of democracy through a number of different channels. Cities offer better access to education and facilitate organised public action and the demand for more democratic rule and respect of human rights. The nexus between urbanisation and human rights is the theme that is taken up in the present paper. Using a sample of 123 countries for the period 1981–2011, the paper examines empirically the association between urbanisation and human empowerment using the Cingranelli-Richards Index. In broad terms, the findings reported herein do not point to a strong nexus across all income groups. Nevertheless, there is evidence suggesting the presence of such a statistically significant positive association in specific cases.

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