scholarly journals A Implementation of Antibiotic Prophylaxis Program for Cesarean Section at Thai Nguyen National Hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nguyen Thi Thu Thuy ◽  
Nguyem Thanh Hai ◽  
Nguyem Xuan Bach ◽  
Hoang Thi Thu Huong ◽  
Nguyem Chi Cuong ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Viet Nam ◽  
National Hospital ◽  
Ministry Of Health

This study aims to evaluate the effectiveness of the use of antibiotic prophylaxis in cesarean section at Thai Nguyen National Hospital as a first pilot activity of a surgical prophylaxis program. In the study, a randomized controlled trial was designed with two groups: intervention group and control group. Patients characteristics and effectiveness of prophylactic antibiotics for caesarean section were compared. The study results show that the patients’ ages ranged from 18 to 44 years; most of the patients had ASA score of 1; and mean hospital length of stay was statistically significant between the two groups (p<0.05). Regarding the indication of caesarean section, the reason of genital tract abnormalities accounted for the highest proportion. The percentage of the patients switching from prophylactic antibiotic regimens to therapeutic antibiotics in the intervention group was 2%. There was no patient with superficial and/or deep incisional surgical site infections in both groups. The difference in mean number of injections in the two groups was statistically significant (p<0.05). The average cost of antibiotics for each patient in the intervention group and control group were 267.720 VND and 543.871 VND, respectively. The study concludes that the effectiveness of antibiotics prophylaxis for caesarean section: 99% of the patients were without wound infection; hospital length of stay in the intervention group was shorter than the control group; and using prophylactic antibiotics was not only more economical but could also reduce the workload of medical staff, costs of antibiotics and medical supplies. Keywords  Antibiotics prophylaxis, caesarean section, Thai Nguyen National Hospital. References [1] Viet Nam Ministry of Health, National guideline on prevention of surgical site infection, issued with Decision No. 3671/QD-BYT, September 27, 2012 of Viet Nam Ministry of Health, Ha Noi, 2012 (in Vietnamese).[2] Viet Nam Ministry of Health, National guideline on antibiotics use, issued with Decision No.708/QD-BYT, March 2, 2015 of Viet Nam Ministry of Health, Ha Noi, 2015 (in Vietnamese).[3] D.W. Bratzler, K.M. Olsen, et al., Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, American Journal of Health-System Pharmacy 70 (2013) 195 – 283. https://doi.org/10.2146/ajhp120568.[4] R.F. Lamont, J.D. Sobel, et al., Current debate on the use of antibiotic prophylaxis for caesarean section, BJOG: An International Journal of Obstetrics & Gynaecology 118 (2011) 193-201. https://doi.org/10.1111/j.14710528.2010.02729.x.[5] T.V. Khai, Infection rate of surgical incisions and associated factors on women after cesarean section at Dong Nai General Hospital, Scientific Research Project of Dong Nai Hospital, 2015 (in Vietnamese).[6] N.H. Tuan, Study on the use of cefazolin to prevent infection after cesarean section or uterine fibroids surgery at the Institute of maternal and neonatal protection, Master’s thesis, Hanoi University of Pharmacy, 2002 (in Vietnamese).[7] F.M. Smaill, R.M. Grivell, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, Cochrane Database Syst Rev 10 (2014) CD007482. https://doi.org/10.1002/14651858.cd007482.pub3.    

Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

scholarly journals The impact of preoperative education in satisfaction and postoperative outcomes of patients undergoing cardiac surgery

2019 ◽  
Vol 2 (1) ◽  
pp. 46
Author(s):  
Antonia Kalogianni ◽  
Georgios Georgiadis ◽  
Olga Katselou ◽  
Olga Kadda ◽  
Aikaterini Sotiropoulou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intervention Group ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Patient Centered ◽  
Preoperative Education ◽  
Elective Cardiac Surgery ◽  
The Impact

Introduction: The effectiveness of preoperative education in postoperative course of cardiac surgery patients has been questioned. Aim: To estimate the impact of preoperative education in satisfaction and postoperative outcomes of patients undergoing cardiac surgery. Material and Method: A quasi-experimental trial was conducted. Sixty nine patients who admitted for elective cardiac surgery were divided randomly in intervention (34) and control group (35). Intervention group received written and verbal education based on patient centered communication by specially trained nurses. Patients’ satisfaction, postoperative complications and hospital length of stay (LOS) was measured. Results: Scores on all dimensions of satisfaction were greater for intervention group (p<0,001).No difference found for complications in intensive care unit (ICU) (p=0,150) in both groups. The total complications was lower (p=0,028) in intervention group with a lower proportion of arrhythmia (p=0,011). The median LOS in ICU was shorter for intervention group (p=0,035). No difference found in median hospital LOS in either group. Conclusions: Nurse-led preoperative education increases satisfaction of patients undergoing cardiac surgery and may have an effect on LOS shortening and complications control.

Implementing an emergency department EMR trigger tool for palliative medicine consultation and its effect on length of stay and health care costs: A retrospective study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 167-167
Author(s):  
Dmitry Kozhevnikov ◽  
Felix Rivera ◽  
Wendy Edwards
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Palliative Medicine ◽  
Metastatic Cancer ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Control Group ◽  
Trigger Tool

167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. Methods: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR. Patients who met criteria for a palliative consultation as determined by ED physicians at the time of inpatient admission were tracked by the palliative medicine department as part of a pilot phase. Those that were triggered and received usual care made up the control group. The intervention group was made up of patients who were triggered and seen in consultation. Results: Patients who were seen within 3 days of trigger were found to have a mean length of stay of 7.57 days, while those seen after 3 days had a mean length of stay 10.61 days. Patients who were triggered for metastatic cancer were found to have differences in final disposition between the two groups. Discharge to subacute rehabilitation facilities (SAR) in these patients decreased from 24% in the control group to 12% in the intervention group, while use of home hospice more than doubled to 11%. The percentage of these patients dying in the hospital decreased from 18% to 12%. Conclusions: Our study showed that earlier consultation was associated with shorter hospital length of stays if patients were seen within 3 days of being flagged as having palliative care needs in the ED. We also found that our EHR trigger doubled home hospice utilization in patients with metastatic cancer, decreased the proportion of discharges to SAR, and decreased in-hospital death in these patients.

scholarly journals Effect of leg wrapping technique on prevention of spinal induced hypotension and fetal acidosis during cesarean section: Randomized controlled trial

2019 ◽  
Vol 10 (2) ◽  
pp. 70
Author(s):  
Samah Nasser Abd El-Aziz El-Shora ◽  
Amina Mohamed Rashad El-Nemer
Keyword(s):  
Randomized Controlled Trial ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cost Effective ◽  
Control Group ◽  
Induced Hypotension ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Wrapping Technique

Background and aim: Hypotension during cesarean section (CS) under spinal anesthesia has been a subject of scientific study for more than 50 years and the search for the most effective strategy to achieve hemodynamic stability remains challenging. Aim: The study was carried out to apply leg wrapping technique for the prevention of spinal-induced hypotension (SIH) during CS.Methods: Randomized Controlled Trial design was utilized at cesarean delivery operating room Mansoura General Hospital in El-Mansoura City during the period from May 2018 to November 2018. A purposive sample of 88 pregnant women, assigned randomly to an intervention group (n = 44) in which their legs wrapped with elastic crepe bandage and control group (n = 44) in which no wrapping was done. Data collected for maternal, neonatal hemodynamic and signs of hypotension, the feasibility of application and cost analysis.Results: There was a statistically significant difference in the incidence of SIH and Ephedrine use among both groups (18.20% in leg wrapping group whereas 75% in control group). In addition, neonatal acidosis and NICU admission were less among leg wrapping group (11.40%, 9.10% respectively). Economically, leg wrapping technique was cost effective compared to the cost of the hospital regimen for treating SIH and admission to (NICU).Conclusion and recommendations: Leg wrapping technique was cost effective and an efficient method for decreasing SIH, neonatal acidosis and Ephedrine administration. It is recommended to apply leg wrapping technique in maternal hospitals' protocol of care for decreasing SIH during CS.

Effect of aromatherapy massage with orange essential oil on postoperative pain after cesarean section: a randomized controlled trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Seyedmohammad Mirhosseini ◽  
Ali Abbasi ◽  
Nastaran Norouzi ◽  
Fatemeh Mobaraki ◽  
Mohammad Hasan Basirinezhad ◽  
...  
Keyword(s):  
Side Effects ◽  
Essential Oil ◽  
Cesarean Section ◽  
Statistical Tests ◽  
Intervention Group ◽  
Nursing Intervention ◽  
Anxiety Score ◽  
Control Group ◽  
And Control ◽  
Orange Essential Oil

Abstract Objectives Many women in recent years have been willing to undergo puncture surgery for childbirth, which, like other surgeries, has physical and psychological side effects such as incision, infertility, chronic pain, and anxiety. Therefore, it is important to reduce and improve these side effects. The aim of this study was to determine the effect of foot massage with orange essential oil on pain and anxiety in women undergoing cesarean section. Methods This randomized clinical trial study was conducted in 2019 on 80 women referred to Bahar Shahroud Hospital after cesarean section surgery. The samples were divided into two groups by intervention (foot massage with orange essential oil) and control (foot massage without orange essential oil). The Spielberger scale was used to determine anxiety scores after cesarean section. In the intervention group, the feet were massaged with orange essential oil, and in the control group, the orange essential oil massage was performed without oil. Anxiety before, immediately after, and 60 min after the intervention was measured and evaluated in both groups. Data analysis was performed using descriptive and inferential statistics. Significant levels were considered for all statistical tests (p<0.05). Results The anxiety score before the intervention in the two groups of intervention and control was 57.12 ± 3.12 and 57.07 ± 3.54, respectively, which were not significantly different, but immediately after the intervention, the anxiety scores in both groups decreased significantly so that there was a further decrease in the intervention group (52.10 ± 4.75 and 56.02 ± 3.77), 1 h after the intervention, the anxiety score in the intervention group decreased compared to the previous stage and increased in the control group (50.40 ± 3.74 and 56.85 ± 4.27). Conclusions Foot massage with orange essential oil can probably be effective as a proper nursing intervention in reducing anxiety after cesarean section surgery.

The Effect of Reflexology on Lactation in Women Who Had Cesarean Section: A Randomized Controlled Pilot Study

2021 ◽  
pp. 1-8
Author(s):  
Sevde Aksu ◽  
Pelin Palas Karaca
Keyword(s):  
Pilot Study ◽  
Cesarean Section ◽  
Intervention Group ◽  
Control Group ◽  
Breast Pain ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Right ◽  
Documentation Tool ◽  
And Control

<b><i>Aim:</i></b> The research was conducted as a randomized controlled pilot study to evaluate the effects of reflexology on lactation in mothers who delivered by cesarean section (CS). <b><i>Methods:</i></b> A single-blind randomized controlled experimental study was conducted with a total of 60 postpartum women in the reflexology application (<i>n</i> = 30) and control groups (<i>n</i> = 30). After the CS, the mothers in the control group were given approximately 3-h routine nursing care after recovering from the effects of anesthesia; the introductory information form was applied, and the Breastfeeding Charting System and Documentation Tool (LATCH) and visual analog scale (VAS) for the signs of the onset of lactation were implemented on the first and second days. Reflexology was applied to the women in the intervention group after an average of 3 h following the mother’s condition had become stable and she had recovered from the effects of anesthesia. Reflexology was applied a total of 20 min – 10 min for the right foot, 10 min for the left foot – twice a day with 8-h intervals on the first and second days after CS. After the last reflexology application, the LATCH and VAS for the signs of the onset of lactation were applied. <b><i>Results:</i></b> Of the women, 70% breastfed their babies within 60 min after delivery; 46.7% of the mothers received breastfeeding training and 81.7% needed support for breastfeeding after the CS. The LATCH breastfeeding scores of the women in the intervention group on both days were significantly higher compared to those of the women in the control group (<i>p</i> &#x3c; 0.001). On the first day after the CS, apart from breast pain, there was no significant difference between the two groups in terms of breast heat and breast tension (<i>p</i> &#x3e; 0.05). On the second day after the CS, apart from breast tension, there was no significant difference between the groups in terms of breast heat and breast pain (<i>p</i> &#x3c; 0.05). In the study, women in the intervention group were found to have higher scores in terms of all three symptoms compared to the control group (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> In the study, it was determined that LATCH scores and signs of the onset of breastfeeding increased in the mothers who received reflexology after CS.

scholarly journals Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

2017 ◽  
Vol 127 (4) ◽  
pp. 633-644 ◽  
Author(s):  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Delirium ◽  
Intervention Group ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Treated Group ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients

2011 ◽  
Vol 9 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Dana Lustbader ◽  
Renee Pekmezaris ◽  
Michael Frankenthaler ◽  
Rajni Walia ◽  
Frederick Smith ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Palliative Medicine ◽  
Intervention Group ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Control Group ◽  
Do Not Resuscitate ◽  
Log Rank Test ◽  
The Impact ◽  
Reduced Time

AbstractObjective:The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.Method:A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.Results:Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test,p < 0.01). Time from MICU admission until death was also reduced (log-rank test,p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2test,p < 0.0001).Significance of results:Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

Hysteroscopic management of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hatem Hussein El-Gamal ◽  
Walid El-Basuony Mohammad ◽  
Ahmed Samir Mohamed Zeerban
Keyword(s):  
Quality Of Life ◽  
Caesarean Section ◽  
Controlled Trial ◽  
Intervention Group ◽  
Expectant Management ◽  
Control Group ◽  
Randomised Controlled ◽  
Caesarean Scar Defect ◽  
Interventional Group

Abstract Background Long-term complaints after caesarean section, such as postmenstrual spotting, dysmenorrhea, dyspareunia, or chronic pelvic pain, are frequently described in relation to the presence of a niche. A post-caesarean niche is defined as an indentation in the myometrium at the site of the uterine scar. Two independent prospective cohort studies reported that the presence of a niche after caesarean section increases the risk of postmenstrual spotting for more than 2 days from 15 to 30%. Postmenstrual spotting may be caused by a mechanical outflow problem, with the retention of menstrual blood in a niche, or by the accumulation of blood because of impaired uterine contractions at the site of the niche. Additionally, newly formed fragile vessels in the niche may play a role in the formation of blood or fluid in the niche and uterine cavity. Objective The aim of this study was to compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. Methods This trial is a randomised controlled trial that provides evidence for the (cost) effectiveness of hysteroscopic resection of a niche versus expectant management in women with niche related postmenstrual spotting. It was carried out on 28 cases divided into two equal group. The study was conducted at Ain Shams University on the women reporting postmenstrual spotting after a caesarean section. The primary outcome was the number of days of postmenstrual spotting 6 months after randomization. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, quality of life, women’s satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, also at 6 months after randomization. Results The results of this study show a significant improvement in interventional group after 3 months more than the control group in bleeding micturition characteristics which includes total days of spotting, spotting end of menstruation, intermenstral spotting, discomfort from spotting, dysmenorrhea and daily pain during micturition, after 6 months the two group improved but the interventional group was significantly higher than control group. Regarding the radiological assessment it was found that there was a significant improvement in intervention group more than the control group after 3 months, also the control group improved after 6 months also, but the intervention groups was significantly higher than the control group. The quality of life show a significant increasing in intervention group more than the control group after 3 months of intervention, at the end of follow up the intervention group was significantly higher in quality of life more than the control group. Conclusion A hysteroscopic niche resection reduces postmenstrual spotting, and the discomfort from spotting, compared with expectant management after 3 months of follow-up in women with a niche with a residual myometrium of at least 3 mm.

Sign in / Sign up

Export Citation Format

Share Document