Video assisted thoracoscopy as a therapeutic modality in evacuating retained or clotted haemothoraces

2021 ◽  
pp. 1-10
Author(s):  
Ambreen Abid ◽  
Tanveer Ahmad ◽  
Khalil Ahmed Shaikh ◽  
Shagufta Nasreen ◽  
Nazish Sikander ◽  
...  
Keyword(s):  
Chest Tube ◽  
Length Of Hospital Stay ◽  
Therapeutic Modality ◽  
Effective Technique ◽  
Video Assisted ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Lung Expansion ◽  
Hospital Stays

Abstract Objective: To determine the role of VATS (Video Assisted Thoracoscopy) for evacuating retained / clotted haemothorax resulting in minimising the duration of chest tube drainage and length of hospital stay. Methods: From July 2019 to February 2020, 160 consecutive patients underwent VATS for retained or clotted haemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre. Institutional review board approval and consent from all patients taken. Outcome was measured as partial or complete lung expansion and relapse of collection. Results: There were 128 (80%) male and 32 (20%) female. 103 (64.37%) patients underwent VATS in first week (2-7) and 57 (35.63%) in second week (8-14 days). Of 103 patients who underwent VATS the first week, (71.9%) had complete lung expansion which was significantly higher compared to those who underwent VATS in second week (28,1%). Ninety-nine participants had chest tube removed in first week of VATS. Participants who underwent VATS in first week had shorter duration of stay (p=0.000). Conclusion: VATS is a safe, reliable and effective technique for the evacuation of retained haemothorax in haemodynamically stable patients. Early intervention within first week of injury not only is associated with better outcome but shorter duration of hospital stays. Keywords: VATS, blunt trauma, Clotted haemothoraces, Continuous...

scholarly journals Role of Autologous Fibrin Glue (AFG) to Reduce Drainage Volume After Modified Radical Mastectomy for Breast Cancer

2021 ◽  
Vol 15 (4) ◽  
pp. 173
Author(s):  
Yohana Azhar ◽  
Ahmad Iffa Maududy ◽  
Nadjwa Zamalek Dalimoenthe
Keyword(s):  
Breast Cancer ◽  
Fibrin Glue ◽  
Length Of Hospital Stay ◽  
Radical Mastectomy ◽  
Control Group ◽  
Autologous Fibrin Glue ◽  
Life Threatening ◽  
Hospital Stays ◽  
Prolonged Hospital

Background: Seroma is arguably the most significant complication that can happen after mastectomy. Although seroma is not a life-threatening complication, this condition can lead to severe morbidities. This situation can cause prolonged hospital stays and delayed adjuvant therapy. In this regard, autologous fibrin glue is a hemostatic agent that can accelerate fibrin formation, stop vascular oozing, and decrease dead space. Therefore, this research was performed to evaluate autologous fibrin glue function in lowering seroma volume after mastectomy and shortening the length of hospital stay.Methods: This randomized control trial research was designed to compare the effect of autologous fibrin glue to a control group that did not receive autologous fibrin glue. Seroma volume was calculated every 24 hours. The drains were then removed after the production of seroma less than 30 mL/24 hours.Results: We recruited 20 patients for each of the two groups who met the inclusion criteria. Age, histopathology type, breast cancer stage, number of lymph nodes, and tumor size did not significantly differ. However, patients in the fibrin glue group had significantly lower cumulative drain production. The median seroma volume in the treatment group was 9.30 mL, while the median in the control group was 20.90 mL (p < 0.05).Conclusions: Autologous fibrin glue significantly decreased seroma formation and length of hospital stay.

Can excisional biopsy be avoided for papillary breast lesions with typical benign sonographic features and concordant core needle biopsy (CNB)?

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 26-26
Author(s):  
Winnie Fu ◽  
David Motiuk ◽  
Tracy Elliot ◽  
Bobbie Docktor
Keyword(s):  
Surgical Excision ◽  
Excisional Biopsy ◽  
Chi Square ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Benign Pathology ◽  
Papillary Lesions ◽  
Smooth Margin

26 Background: The role of surgical excision in the management of papillary lesions remains controversial. Some studies have documented upgrade rates to malignancy or atypia as high as 17%. However, due to the inclusion of atypia or malignancy at percutaneous and other differences in methodology, these rates may have been over-estimated. This study was designed to determine sonographic features that can help to decide if a lesion warrants excision or standard follow-up. Methods: With institutional review board approval, we retrospectively reviewed 113 benign papillomas without atypia that were diagnosed at US-guided CNB at Foothills Medical Centre from 2005 to 2010. Surgical pathology for 62 of these lesions were assessed. Two radiologists who were blinded to the diagnosis reviewed the sonographic images to determine the likelihood of benignity. Statistical analysis was performed using chi-square and z-score tests. Results: In our study, 5.3% of benign papillomas were upgraded. The sonographic features associated with a higher likelihood of upgrade were intracystic type [LR+ 5.67, 95% CI (1.47,12)], non-periareolar location [LR+ 2.30, 95% CI (1.04,5.06)], complex echogenic pattern [LR+ 3.10, 95% CI (1.00,9.63)], and radiologist’s impression of unlikely benign (final BiRADS) [LR+ 1.48, 95% CI (1.01,1.90)]. Although no feature was statistically significant for greater likelihood of benignity, the sonographic features that may better predict benign pathology at excision include lesions <1cm in size [LR- 0.52], homogeneously solid [LR- 0.63], smooth margin [LR- 0.69] and periareolar location [LR- 0.47]. Conclusions: The management of benign papillomas diagnosed with CNB remains controversial with a lack of agreement among published articles. Our study identifies characteristic sonographic features that are associated with higher likelihood of malignancy, warranting surgical excision. Conversely, it may not be unreasonable to place patients with lesions that are stratified as low risk into standard radiographic follow-up. As the confidence intervals span 1.00 for latter, further study is necessary to confidently recommend follow-up in place of excision.

The Institutional Review Board and Protecting Human Subjects: 10 Frequently Asked Questions

2005 ◽  
Vol 15 (3) ◽  
pp. 291-295
Author(s):  
Sheldon Zink ◽  
Laura Kimberly ◽  
Stacey Wertlieb
Keyword(s):  
Human Subjects ◽  
Institutional Review Board ◽  
Institutional Review Boards ◽  
Research Subjects ◽  
Human Research ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Human Research Subjects ◽  
Review Boards

It is essential that anyone involved in research involving human subjects be familiar with the purpose and role of institutional review boards. Institutional review boards are designed, first and foremost, to protect human research subjects by overseeing the implementation of federal regulations regarding protection of human subjects. The federal government requires institutional review board approval for any human subject research that receives federal funding, and many scholarly journals require proof of institutional review board approval of the research before publication. In this article, the answers to 10 frequently asked questions about the role of institutional review boards highlight the important contributions made by institutional review boards to the conduct of ethically sound research. The aim is to generate a working knowledge of the institutional review board's function that can be used by every researcher contemplating working with human research subjects. This is the first in a series of 3 articles examining common issues in research ethics.

scholarly journals Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

2021 ◽  
Author(s):  
Lucy Bayer-Oglesby ◽  
Andrea Zumbrunn ◽  
Nicole Bachmann ◽  
Keyword(s):  
Health Literacy ◽  
Social Factors ◽  
Chronic Conditions ◽  
Length Of Hospital Stay ◽  
Main Diagnosis ◽  
Discharge Destination ◽  
Low Health Literacy ◽  
Hospital Stays ◽  
Prolonged Hospital

AbstractBackgroundSocial factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. Low education level and lack of social and financial resources have been associated with prolonged hospital stays while for migration factors evidence is inconclusive. The objective of this study was i) to assess the associations of social factors with length of hospital stays for chronic conditions, ii) to investigate the role of comorbidity and discharge destination in mediating these associations and iii) to identify the main drivers of length of stays.MethodsThis analysis made use of nationwide inpatient data from Swiss hospital discharge statistics that was linked on the individual level with Swiss census data. The study sample included n=141,307 records of n=92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for acute care in Switzerland with a main diagnosis of one of 15 selected chronic conditions, including cancers and cardiovascular, respiratory and musculoskeletal diseases. Cross-classified multilevel models were used to assess the impact of social factors on length of hospital stay and for mediation analysis in the retrospective inpatient cohort.FindingsThe strongest determinants of length of stay were medical factors, namely main diagnosis (up to seven days difference), comorbidities (up to 10 days) and treatment-related factors (two to three days). Also, social factors were associated with duration of hospital stays. Taking into account demographic factors, main diagnosis and clustering on patient and hospital level, patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively). However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients, first generation migrants and non-EU/EFTA-nationals had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55; β 0.16, 95% CI 0.05-0.27; β 0.22, 95% CI 0.02, 0.42, resp.).ConclusionsHospital stays could be a window of opportunity to discern patients with low health literacy who need additional instructions and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs such as interpreter services or rehabilitation due to lack of language skills or lack of immediate support at home, respectively, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system. Our findings underpin the importance of health policies promoting shared decision making and patient-centred care tailored to the differential needs of social and cultural groups.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

Role of video assisted teaching in counselling to make decision for organ donation

2019 ◽  
Vol 2 (6) ◽  
pp. 145-148
Author(s):  
Sumesh Kumar ◽  
Sarita Bagaria ◽  
Moirangthem Sonia ◽  
Kailash Kumar Khandelwal
Keyword(s):  
Organ Donation ◽  
Vital Role ◽  
Health Team ◽  
Video Assisted ◽  
Knowledge Questionnaire ◽  
Structured Knowledge ◽  
Spss Software ◽  
Knowledge And Attitude ◽  
Post Assessment

Decision of organ donation has enormous potential to save countless lives and health team play a vital role in counselling of patients and their family in decision making regarding organ donation in the ultimate stage of life. For this reason, evaluation of factors which can enhance knowledge and positive attitude towards organ donation has paramount importance. Present study aims to assess the knowledge and attitude of adults regarding organ donation and to find out role of video assisted teaching in behaviour modulation. Data from 80 participants were collected using a structured knowledge questionnaire. Pre-assessment was done before intervention of video-assisted teaching and post-assessment was done following that. Data were analyzed through SPSS software using Spearman’s Rank Co-relation. We found a negative co-relation (rK= -0.1122) between knowledge & attitude of adults regarding organ donation before video-assisted teaching regarding organ donation. A direct and positive co-relation (rK=+0.294) was observed between knowledge and attitude of adults regarding organ donation after video assisted teaching. We found that video assisted counselling provided by the medical team has great potential in promoting actions regarding organ donation. It is recommended that video assisted counselling should be applied to enhance knowledge and attitude regarding organ donation among general population.

Effect of Surgical Versus Pharmacological Decompression of Ludwig’s Angina on Airway Compromise among Nigerian Patients

2020 ◽  
Author(s):  
Ekaniyere EB
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Decompression ◽  
Airway Compromise ◽  
Inclusion Criteria ◽  
Hospital Stays ◽  
Ludwig’S Angina ◽  
The Mean ◽  
The University ◽  
Ludwig's Angina ◽  
Gender Type

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.

scholarly journals A triple combination of treatments on moderate COVID-19

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 769-772
Author(s):  
ChunMiao Bao ◽  
BinBin Li ◽  
YuFeng Zhou
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Convincing Evidence ◽  
Triple Combination ◽  
Viral Shedding ◽  
Null Effect ◽  
Treatment Start

Abstract Objective A triple combination of interferon (IFN) α-2b, lopinavir tablets, and umifenovir was used to treat COVID-19 patients. It is important to explore whether the benefit of this therapy is time dependent. Methods A cohort of moderate COVID-19 patients (n = 54) was admitted for hospitalization. The demographic (age, gender, and smoking status) and clinical characteristics (epidemiological trace and comorbidity) were collected from the digital medical records. The length of hospital stay (LOS) and the viral shedding time (VST) were set as the outcomes for COVID-19 cases. Results After control for age, sex, epidemiological trace, smoking, and comorbidity, the time of treatment start had null effect on VST (IRR = 1.09; 95% CI = 0.91–1.30; p = 0.33) or LOS (IRR = 1.10; 95% CI = 0.94–1.28; p = 0.23). Conclusion There is no convincing evidence to support a pivotal role of the timing of the therapy in the prognosis of moderate COVID-19 cases.

scholarly journals Management of superficial and deep surgical site infection: an international multidisciplinary consensus

2021 ◽  
Author(s):  
Gabriele Sganga ◽  
Mohamed Baguneid ◽  
Pascal Dohmen ◽  
Evangelos J. Giamarellos-Bourboulis ◽  
Emilio Romanini ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Early Discharge ◽  
Multidrug Resistant ◽  
Steering Committee ◽  
Resistant Bacteria ◽  
Modified Delphi ◽  
Hospital Stays ◽  
New Treatment ◽  
The Impact

AbstractSurgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.

scholarly journals Comparison of non-intubated and intubated video-assisted thoracoscopic surgeries of major pulmonary resections for lung cancer—a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wenfei Xue ◽  
Guochen Duan ◽  
Xiaopeng Zhang ◽  
Hua Zhang ◽  
Qingtao Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Chest Tube ◽  
Meta Analysis ◽  
Tube Placement ◽  
Postoperative Complication Rate ◽  
Chest Tube Placement ◽  
Video Assisted

Abstract Objective The aim of this study was to compare the safety feasibility and safety feasibility of non-intubated (NIVATS) and intubated video-assisted thoracoscopic surgeries (IVATS) during major pulmonary resections. Methods A meta-analysis of eight studies was conducted to compare the real effects of two lobectomy or segmentectomy approaches during major pulmonary resections. Results Results showed that the patients using NIVATS had a greatly shorter hospital stay and chest-tube placement time (weighted mean difference (WMD): − 1.04 days; 95% CI − 1.50 to − 0.58; P < 0.01) WMD − 0.71 days; 95% confidence interval (CI), − 1.08 to − 0.34; P < 0.01, respectively) while compared to those with IVATS. There were no significant differences in postoperative complication rate, surgical duration, and the number of dissected lymph nodes. However, through the analysis of highly selected patients with lung cancer in early stage, the rate of postoperative complication in the NIVATS group was lower than that in the IVATS group [odds ratio (OR) 0.44; 95% CI 0.21–0.92; P = 0.03, I2 = 0%]. Conclusions Although the comparable postoperative complication rate was observed for major thoracic surgery in two surgical procedures, the NIVATS method could significantly shorten the hospitalized stay and chest-tube placement time compared with IVATS. Therefore, for highly selected patients, NIVATS is regarded as a safe and technically feasible procedure for major thoracic surgery. The assessment of the safety and feasibility for patients undergoing NIVATS needs further multi-center prospective clinical trials.

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