scholarly journals Evaluation of possum scoring system in patients undergoing laparotomy

2019 ◽  
Vol 6 (2) ◽  
pp. 512
Author(s):  
Manoharan G. V. ◽  
Vijayalakshmi G.
Keyword(s):  
Scoring System ◽  
Elective Surgery ◽  
High Risk Patient ◽  
Surgical Care ◽  
Scoring Systems ◽  
Patient Counseling ◽  
Emergency Group ◽  
Set Up ◽  
Prediction Of Complications

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient is at risk of developing complications contributes to the quality of surgical care and cost reduction in surgery. Among the variety of scoring systems used to identify the “high risk” patient POSSUM scoring is the most widely used.Methods: Patients undergoing laparotomy were selected serially and their physiological severity score on admission and operative severity scored at the end of 30days and compared with the POSSUM predicted score.Results: In the elective surgery group, patients with morbidity correlated with high POSSUM scores but due to low overall morbidity conclusions could not be drawn while in the emergency group predicted morbidity correlated well with observed results. The low overall mortality in the study group precluded meaningful analysis.Conclusions: POSSUM scoring system has an undeniable advantage in this set up for better patient counseling, improving the surgical outcomes in both emergency and elective wards and for better management of limited resources and manpower.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

DOZ047.62: Fixed the gap, solved the problem? Children operated on of esophageal atresia: what happen 3 years later

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F Bevilacqua ◽  
B Ragni ◽  
A Conforti ◽  
F Morini ◽  
A Dotta ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Surgical Care ◽  
Health Care Team ◽  
Eating Problems ◽  
Respiratory Problems ◽  
Feeding Difficulties ◽  
Meal Time ◽  
Set Up

Abstract Background With improvements in surgical care long-term morbidity of patients with esophageal atresia (EA) has been recently taken into account (Lees et al., 2018). Morbidities include gastrointestinal and respiratory complication, problems of nutrition and growth, feeding difficulties, oral aversion or food refusal (Menzies et al., 2016). Aim Purpose of this study is to explore eating problems and its implications at 3 years in infants born with esophageal atresia. Methods A retrospective study including all infants operated for EA at our Institution in the period ranging from January 2012 and January 2016 who attended our follow-up program. A specific interview was set up for the study. The interview was delivered by telephone by a trained psychologist. Results Parents of 51 children (male = 67%) were interviewed. Twenty-two percent of children showed a growth <10th percentile; 30% presented oral aversion for a period of their life; 45% still have episodes of chock during meals and 18% of these had more than one episode a week; 45% suffer of GERD and 41% experienced recurrent respiratory problems; 37% of parents experience anxiety during meals. Fifty-seven percent attended kindergarten (8% with a dedicated educator during meal time), and 92% attended preschool (26% with dedicated educator during meal time). Currently 67% of the families benefit of social facilities. Conclusions Three years after surgical repair of the structural defect, a high percentage of family still experience physical and psychological problems related to eating behavior of their children. Efforts of the health care team as well as research should focus on how to prevent eating problems and improve quality of life both of children and families.

scholarly journals Intestinal Ostomies Created During Emergency Surgery Possess Unique Challenges

2020 ◽  
Author(s):  
Wibke Schulte ◽  
Ilhamiyya Aliyeva ◽  
Michael Knoop ◽  
Johann Pratschke
Keyword(s):  
Emergency Surgery ◽  
Online Survey ◽  
Elective Surgery ◽  
Surgical Care ◽  
Wound Dehiscence ◽  
University Hospital ◽  
Complication Rates ◽  
Emergency Patients ◽  
Artificial Opening

Abstract Background: The surgical creation of an artificial opening of the bowel, called ostomy, can become necessary for very different causative diseases. A special subgroup are ostomies created during emergency surgery, which pose particular challenges to affected patients. This work is dedicated to their detailed characterization.Methods: A retrospective analysis of surgical ostomy creations at an acute care university hospital and an online survey for patients with an ostomy were performed and evaluated.Results: In our study, about one third of all ostomies were created during emergency surgery (37.4%). Compared to patients who received an ostomy during elective surgery, emergency patients had a higher ASA score and diagnoses requiring acute surgical care. Patients undergoing emergency surgery were more likely to have inadequate preoperative medical education (60% vs. 33.3%, p=0.029), and rarely received preoperative ostomy marking (4% vs. 79.2%, p<0.001). Emergency patients underwent minimally invasive surgery less frequently (26.8% vs. 51.3%, p=0.001), and showed a higher rate of peristomal wound dehiscence (9.9% vs. 2.5%, p=0.028). Accordingly, emergency ostomies often resulted in an overall reduction in postoperative quality of life.Conclusion: Ostomies are often created during emergency surgery under suboptimal perioperative conditions. This results in higher complication rates and negative physical and psychological effects. Therefore, intensive interdisciplinary care is essential to provide the best possible care for patients affected by these artificially created intestinal outlets.

scholarly journals The New Jersey Bowel Preparation Scale: A More Objective and Detailed Scoring System for Screening Colonoscopies

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Qasim Salimi ◽  
Thayer Nasereddin ◽  
Neel Patel ◽  
Reza Hashemipour ◽  
Augustine Tawadros ◽  
...  
Keyword(s):  
New Jersey ◽  
Bowel Preparation ◽  
Scoring System ◽  
Intraclass Correlation ◽  
Scoring Systems ◽  
University Hospital ◽  
Screening Colonoscopy ◽  
Single Center ◽  
Hospital Patients

Goals. The goal of this study was to develop an objective and detailed scoring system to assess the quality of bowel preparation. Background. The quality of bowel preparation impacts the success of the colonoscopy. We developed and compared a new bowel preparation scoring system, the New Jersey Bowel Preparation Scale (NJBPS), with existing systems that are limited by a lack of detail and objectivity in the Boston Bowel Preparation Scale (BBPS) and the Ottawa Bowel Preparation Scale (OBPS). Methods. This was a single-center, prospective, dual-observer study performed at Rutgers New Jersey Medical School University Hospital. Patients who were at medium risk for colorectal cancer and undergoing outpatient screening colonoscopy were enrolled in the study, and their bowel preparation was assessed separately by an attending and a fellow using each of the bowel preparation scoring systems. Results. 98 patients were analyzed in the study, of which 59% were female. Most of the patient population was African American (65%) or Hispanic (25%). The average age of the patient was 60 years. Chi-squared analysis using SPSS software revealed intraclass correlation coefficient values between attending and fellow scores for each scale. The NJBPS had the highest value at 0.988, while the BBPS and OBPS had values of 0.883 and 0.894. Limitations. Single-center study. Conclusions. The NJBPS and BBPS scores demonstrated a statistically significant agreement with each other. Overall, there was good interobserver agreement for all three scoring systems when comparing attendings to fellows for the same scoring system. However, the NJBPS possessed a stronger correlation.

scholarly journals The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures

2021 ◽  
Author(s):  
A. Picciariello ◽  
P. Lobascio ◽  
L. Spazzafumo ◽  
M. Rinaldi ◽  
R. Dibra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Fissure ◽  
Scoring System ◽  
Obstructed Defecation ◽  
Control Group ◽  
Tertiary Centre ◽  
Significant Difference ◽  
Highly Correlated ◽  
Set Up

Abstract Background Anal fissure (AF) is a common, painful disease that strongly affects patients’ quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. Methods The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020–September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. Results One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. Conclusions The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.

scholarly journals Assessment of surgical outcome in emergency gastrointestinal surgeries using P-POSSUM score

2017 ◽  
Vol 5 (7) ◽  
pp. 3007
Author(s):  
Prasan Kumar Hota ◽  
Harshita Yellapragada
Keyword(s):  
Health Care ◽  
Surgical Outcome ◽  
Scoring System ◽  
Statistical Significance ◽  
Surgical Care ◽  
Mortality And Morbidity ◽  
Possum Score ◽  
Operative Severity Score ◽  
Significant Difference

Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and its modification, Portsmouth-POSSUM (P-POSSUM), are considered as methods of risk scoring. Application of this scoring system helps in assessing the quality of the health care provided and surgical outcome. Its utilization in our country where the level of healthcare and resources differ is limited. Hence, a prospective study to assess the outcome of emergency GI surgeries using P-POSSUM scoring system in a teaching hospital at district level was taken up.Methods: 80 cases which underwent emergency GI surgeries were studied. Using P-POSSUM equation, predicted mortality and morbidity rates were calculated and compared with the actual outcome. Statistical significance was calculated using chi square test.Results: An observed to expected ratio of 0.71 and 0.60 was obtained for mortality and morbidity respectively. No significant difference was noted between expected to observed mortality and morbidity rates with P=0.23 and P=0.09 for mortality and morbidity respectively, suggesting a reasonably good quality of outcome. P-POSSUM over predicted mortality and morbidity in low risk groups while it accurately predicted the outcome in high risk groups.Conclusions: The quality of surgical care provided and surgical outcome are comparable to other health care systems, with observed to expected mortality and morbidity ratio being nearly same. P-POSSUM can be used as a tool for outcome audits.

scholarly journals Acute chemotherapy-induced nausea and vomiting in children with cancer: Still waiting for a common consensus on treatment

2018 ◽  
Vol 46 (6) ◽  
pp. 2149-2156 ◽  
Author(s):  
Antonio Ruggiero ◽  
Daniela Rizzo ◽  
Martina Catalano ◽  
Paola Coccia ◽  
Silvia Triarico ◽  
...  
Keyword(s):  
Scoring System ◽  
Scoring Systems ◽  
Paediatric Oncology ◽  
Nausea And Vomiting ◽  
Oncology Patients ◽  
Treatment Side Effects ◽  
Antiemetic Treatment ◽  
Antiemetic Drugs ◽  
Potential Risk Factors

Chemotherapy-induced nausea and vomiting (CINV) is one of the most common treatment side-effects, and remains a significant concern, in children undergoing chemotherapy. Although adult patients receive chemotherapy regimens combined with appropriate standardized antiemetic treatment, children can receive markedly varying antiemetic treatments. A narrative review of CINV was performed regarding CINV definition, scoring system, prevention and treatment, specifically focussing on studies conducted with paediatric oncology patients. The review highlighted a lack of rigorously developed CINV scoring systems and standardized CINV pharmacological treatment for paediatric oncology patients. Different scoring systems were found to identify potential risk factors for CINV associated with the use of several different antiemetic drugs, however, few studies have been performed in children undergoing chemotherapy. Thus, CINV remains a distressing and partially controlled side-effect in the paediatric patient population. To reduce emesis and improve quality of life in paediatric oncology patients, standardized antiemetic treatment may be preferred, using a unique CINV scoring system that accounts for the emetogenic level of the chemotherapy regimen adopted and the children’s clinical characteristics.

scholarly journals The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

2020 ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Waiting Time ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Outcome Variable ◽  
Timely Access

Abstract Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.

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