Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to De...Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic. Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis, i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension, i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours, i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%. Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.展开更多
Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study ...Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study started in May 2022 and was terminated in March 2023.During this period,50 patients with ankle fractures treated by our hospital were selected as research subjects.They were divided into a control group and a research group.The control group had 25 patients who received routine care,and the research group had 25 who received evidence-based care.The nursing effects of the two groups were observed and compared.Results:The pain scores,quality of life,incidence of adverse reactions,and nursing satisfaction of patients in the research group were all significantly better than those in the control group(P<0.05).Conclusion:Evidence-based nursing can effectively improve the quality of care,reduce the risk of adverse reactions,and promote patient recovery,so it is suitable for clinical implementation.展开更多
Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery(ERAS), has been generally...Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery(ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.展开更多
A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual a...A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The patient was being treated with G-CSF (Leufokine?) due to her severe congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it. Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery, profuse irrigation with the entire bottle of topical antibiotics (Vigamox?, moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed topical and highly potent systemic antibiotics for 1 week. This is the first case report to describe the successful perioperative antisepsis care following strabismus surgery for a patient with severe congenital neutropenia. Prevention of postoperative infection in granulocytopenic patients could be achieved using antibiotic agents which provide the greatest spectrum of coverage against both Gram-positive and Gram-negative infections.展开更多
Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatm...Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatment for most malignant tumors. However, surgery itself can inhibit important host defenses and promote the development of metastases. An altered balance between the metastatic potential of the tumor and the anti-metastatic host defenses, including cellmediated immunity and natural killer cell function, is a plausible mechanism of increased cancer metastasis. This article reviews the increasingly recognized concept of anesthetic technique along with perioperative factors and their potential to affect long-term outcome after cancer surgery. The potential effect of intravenous anesthetics, volatile agents, local anesthetic drugs, opiates, and non-steroidal anti-inflammatory drugs are reviewed along with recent literature and ongoing clinical trials in this area. Regional anesthesia is increasingly emerging as a safer option with less cancer recurrence potential as compared to general anesthesia. Blood transfusion, pain, stress, use of beta-blockers, and hypothermia are other potentially important perioperative factors to consider.展开更多
Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis.Methods: The medical records of 34 patients(35 eyes) presenting with infectious endophthalmitis...Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis.Methods: The medical records of 34 patients(35 eyes) presenting with infectious endophthalmitis at Zhongshan Ophthalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery.Results:Thirty-four patients(35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient(1 eye) was untreated due to Pseudomonas aeruginosa infection.Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.展开更多
Objective: The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses' practice, and improve the authors' clinic...Objective: The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses' practice, and improve the authors' clinical practice ultimately.Methods: The author used Smyth's model to guide the process of reflection on the practice issue. Critical reflection, critical emancipatory theory, reflexivity, and critical social theory were used to help the author analyze the factors that have affected theater nurses' practice in the organization.Results: There are gaps between the espoused and enacted theories. A theater nurse's practice is determined by multiple factors, such as political, structural, social, historical, cultural issues, and so on. The hierarchy of the health context could hinder possible changes in theater nurses' practice. To better understand our practice and implement transformation, we should shape a supportive environment,bear in mind the practice motto of "patient-centered" care, and improve our knowledge and reflection skills.Conclusions: Reflection plays a significant role in the advancing of practice among theater nurses and needs to be combined with clinical practice. To provide the best service of care to perioperative patients, a theater nurse should have an insightful understanding of the factors that have influenced her/his behaviors historically, socially, and culturally. By improving their critical reflection skills,practitioners could gain knowledge from experience.展开更多
Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 20...Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.展开更多
Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were g...Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.展开更多
Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for pati...Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for patients with hyper-tension undergoing HA.It analyzes the key points of care during the periop-erative period(preoperative,intraoperative,and postoperative)and proposes directions for the development of perioperative nursing care for HA.The pro-gnosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.展开更多
Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative...Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative and quantitative reductions in the availability of functional AChRs.Cardiac muscles are also affected,resulting in various perioperative cardiac complications.Antistriational antibodies are commonly reported in MG cases with cardiac involvement.In the presence of thymoma,the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%.Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia,myocarditis,conduction disorders,heart failure,and sudden death.Increased incidence of atrial fibrillation,ventricular and supraventricular extra systoles,and prolonged QTc have also been reported in patients with MG.Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.展开更多
BACKGROUND Gastric cancer(GC)is the fifth most commonly diagnosed malignancy worldwide,with over 1 million new cases per year,and the third leading cause of cancer-related death.AIM To determine the optimal perioperat...BACKGROUND Gastric cancer(GC)is the fifth most commonly diagnosed malignancy worldwide,with over 1 million new cases per year,and the third leading cause of cancer-related death.AIM To determine the optimal perioperative treatment regimen for patients with locally resectable GC.METHODS A comprehensive literature search was conducted,focusing on phase II/III randomized controlled trials(RCTs)assessing perioperative chemotherapy and chemoradiotherapy in treating locally resectable GC.The R0 resection rate,overall survival(OS),disease-free survival(DFS),and incidence of grade 3 or higher nonsurgical severe adverse events(SAEs)associated with various perioperative regimens were analyzed.A Bayesian network meta-analysis was performed to compare treatment regimens and rank their efficacy.RESULTS Thirty RCTs involving 8346 patients were included in this study.Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared with surgery alone,and the former had the highest probability of being the most effective option in this context.Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for improving OS.Owing to limited data,no definitive ranking could be determined for DFS.Considering nonsurgical SAEs,FLO has emerged as the safest treatment regimen.CONCLUSION This study provides valuable insights for clinicians when selecting perioperative treatment regimens for patients with locally resectable GC.Further studies are required to validate these findings.展开更多
In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(I...In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine learning.The editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict ICUAW.The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW.This editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.展开更多
Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for...Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.展开更多
Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of pre...Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of preconception care. Therefore, the aim of this study was to establish the provision of preconception care by midwives, nurses and doctors at Ndola Teaching Hospital in Zambia. Methods: A concurrent embedded mixed methodology utilising a descriptive explorative study design, where 107 respondents were randomly selected using the lottery technique for quantitative part and two focused group discussions for qualitative part of the study was used. A self-administered questionnaire was used to collect quantitative data and a focus group discussion guide was used for the focus group discussions. Statistical Package of Social Sciences version 26 with significance set at 0.05 and at 95% confidence level and thematic analysis were used for data analysis. Results: 75% of the respondents in this study were not providing preconception care and only 25% of respondents were providing preconception care;however, this was provided randomly because there were no guidelines to follow. Among the respondents, 81.3% had medium knowledge, 70.1% had good practices and 92.5% had positive attitudes towards preconception care. Further analysis showed that the association between preconception care and knowledge, practices and attitudes was not statistically significant (p = values 0.336;0.344;1.000 respectively). Multivariate logistic regression revealed that participants with high knowledge were five times more likely to provide preconception care (OR = 5.00, CI = 0.42 - 59.7, P = 0.203). Generally, all the participants acknowledged that preconception care was an important package that could prevent maternal and child morbidities and mortalities. Conclusions: The study revealed that most of the respondents were not providing preconception care. Provision of preconception was done by a small fraction of the respondents and it was done in an unorderly manner due to lack of set standards and guidelines. Despite medium levels of knowledge and generally good practices and positive attitudes towards preconception care, its random provision indicates a need for established standards to enhance maternal and child health outcomes.展开更多
Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobeha...Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.展开更多
Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, ac...Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.展开更多
In the last decade, the long-term survival among people living with HIV (PLHIV) has significantly improved. This is accompanied by an increased burden of non-communicable diseases such as hypertension due to the combi...In the last decade, the long-term survival among people living with HIV (PLHIV) has significantly improved. This is accompanied by an increased burden of non-communicable diseases such as hypertension due to the combined effect of the aging population and the metabolic effect of the Human Immuno-deficiency Virus (HIV) virion and antiretroviral therapy. This study aims to assess the prevalence and factors associated with hypertension among people living with HIV in three large health facilities in Nasarawa State, Nigeria. A descriptive cross-sectional study employed a multistage sampling technique to select 309 adults with HIV, 18 years and above, receiving HIV care in three large health facilities in Nasarawa State. The outcome variable was the participants’ self-reported history of hypertension, confirmed through a positive history of hypertension treatment. Exposure variables included the participant’s socio-demographic characteristics, lifestyle factors, and HIV care and treatment history. Data were presented using frequency tables. Factors associated with hypertension were assessed using binary logistic regression at a 0.05 level of statistical significance. A total of 309 adults living with HIV were sampled. A larger percentage of the participants were married 228 (73.8%), female, 191 (61.8%), within the age group 41 - 50 years, 141 (45.6%). Most of the participants had no family history of hypertension, 188 (60.8%). The prevalence of self-reported hypertension was 11.0% (34/309). Factors associated with hypertension at the bivariate level were age group 21 - 30 years, 41 - 50 years, being widow/widower, divorced, retired from employment or with family history of hypertension. Only participants age group 31 - 40 years [Adjusted Odd Ratio (AOR): 0.18, 95%CI: 0.04 - 0.91, p = 0.04] and family history of hypertension [(AOR): 83.44, 95%CI: 15.75 - 442.11, p < 0.01] were found to predict hypertension among the study participants after adjusting for confounders. In conclusion, Hypertension remains a public health issue among PLHIV. Factors associated with hypertension among PLHIV include age and family history of hypertension. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.展开更多
Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational ...Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.展开更多
文摘Objective: Describe the perioperative management of peritonitis in surgical emergencies. Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic. Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis, i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension, i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours, i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%. Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.
文摘Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study started in May 2022 and was terminated in March 2023.During this period,50 patients with ankle fractures treated by our hospital were selected as research subjects.They were divided into a control group and a research group.The control group had 25 patients who received routine care,and the research group had 25 who received evidence-based care.The nursing effects of the two groups were observed and compared.Results:The pain scores,quality of life,incidence of adverse reactions,and nursing satisfaction of patients in the research group were all significantly better than those in the control group(P<0.05).Conclusion:Evidence-based nursing can effectively improve the quality of care,reduce the risk of adverse reactions,and promote patient recovery,so it is suitable for clinical implementation.
文摘Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery(ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.
文摘A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The patient was being treated with G-CSF (Leufokine?) due to her severe congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it. Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery, profuse irrigation with the entire bottle of topical antibiotics (Vigamox?, moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed topical and highly potent systemic antibiotics for 1 week. This is the first case report to describe the successful perioperative antisepsis care following strabismus surgery for a patient with severe congenital neutropenia. Prevention of postoperative infection in granulocytopenic patients could be achieved using antibiotic agents which provide the greatest spectrum of coverage against both Gram-positive and Gram-negative infections.
文摘Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatment for most malignant tumors. However, surgery itself can inhibit important host defenses and promote the development of metastases. An altered balance between the metastatic potential of the tumor and the anti-metastatic host defenses, including cellmediated immunity and natural killer cell function, is a plausible mechanism of increased cancer metastasis. This article reviews the increasingly recognized concept of anesthetic technique along with perioperative factors and their potential to affect long-term outcome after cancer surgery. The potential effect of intravenous anesthetics, volatile agents, local anesthetic drugs, opiates, and non-steroidal anti-inflammatory drugs are reviewed along with recent literature and ongoing clinical trials in this area. Regional anesthesia is increasingly emerging as a safer option with less cancer recurrence potential as compared to general anesthesia. Blood transfusion, pain, stress, use of beta-blockers, and hypothermia are other potentially important perioperative factors to consider.
文摘Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis.Methods: The medical records of 34 patients(35 eyes) presenting with infectious endophthalmitis at Zhongshan Ophthalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery.Results:Thirty-four patients(35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient(1 eye) was untreated due to Pseudomonas aeruginosa infection.Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.
文摘Objective: The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses' practice, and improve the authors' clinical practice ultimately.Methods: The author used Smyth's model to guide the process of reflection on the practice issue. Critical reflection, critical emancipatory theory, reflexivity, and critical social theory were used to help the author analyze the factors that have affected theater nurses' practice in the organization.Results: There are gaps between the espoused and enacted theories. A theater nurse's practice is determined by multiple factors, such as political, structural, social, historical, cultural issues, and so on. The hierarchy of the health context could hinder possible changes in theater nurses' practice. To better understand our practice and implement transformation, we should shape a supportive environment,bear in mind the practice motto of "patient-centered" care, and improve our knowledge and reflection skills.Conclusions: Reflection plays a significant role in the advancing of practice among theater nurses and needs to be combined with clinical practice. To provide the best service of care to perioperative patients, a theater nurse should have an insightful understanding of the factors that have influenced her/his behaviors historically, socially, and culturally. By improving their critical reflection skills,practitioners could gain knowledge from experience.
文摘Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.
文摘Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.
文摘Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for patients with hyper-tension undergoing HA.It analyzes the key points of care during the periop-erative period(preoperative,intraoperative,and postoperative)and proposes directions for the development of perioperative nursing care for HA.The pro-gnosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.
文摘Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative and quantitative reductions in the availability of functional AChRs.Cardiac muscles are also affected,resulting in various perioperative cardiac complications.Antistriational antibodies are commonly reported in MG cases with cardiac involvement.In the presence of thymoma,the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%.Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia,myocarditis,conduction disorders,heart failure,and sudden death.Increased incidence of atrial fibrillation,ventricular and supraventricular extra systoles,and prolonged QTc have also been reported in patients with MG.Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.
基金National Natural Science Foundation of China,No.82305347.
文摘BACKGROUND Gastric cancer(GC)is the fifth most commonly diagnosed malignancy worldwide,with over 1 million new cases per year,and the third leading cause of cancer-related death.AIM To determine the optimal perioperative treatment regimen for patients with locally resectable GC.METHODS A comprehensive literature search was conducted,focusing on phase II/III randomized controlled trials(RCTs)assessing perioperative chemotherapy and chemoradiotherapy in treating locally resectable GC.The R0 resection rate,overall survival(OS),disease-free survival(DFS),and incidence of grade 3 or higher nonsurgical severe adverse events(SAEs)associated with various perioperative regimens were analyzed.A Bayesian network meta-analysis was performed to compare treatment regimens and rank their efficacy.RESULTS Thirty RCTs involving 8346 patients were included in this study.Neoadjuvant XELOX plus neoadjuvant radiotherapy and neoadjuvant CF were found to significantly improve the R0 resection rate compared with surgery alone,and the former had the highest probability of being the most effective option in this context.Neoadjuvant plus adjuvant FLOT was associated with the highest probability of being the best regimen for improving OS.Owing to limited data,no definitive ranking could be determined for DFS.Considering nonsurgical SAEs,FLO has emerged as the safest treatment regimen.CONCLUSION This study provides valuable insights for clinicians when selecting perioperative treatment regimens for patients with locally resectable GC.Further studies are required to validate these findings.
文摘In this editorial,we comment on the article by Wang and Long,published in a recent issue of the World Journal of Clinical Cases.The article addresses the challenge of predicting intensive care unit-acquired weakness(ICUAW),a neuromuscular disorder affecting critically ill patients,by employing a novel processing strategy based on repeated machine learning.The editorial presents a dataset comprising clinical,demographic,and laboratory variables from intensive care unit(ICU)patients and employs a multilayer perceptron neural network model to predict ICUAW.The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW.This editorial contributes to the growing body of literature on predictive modeling in critical care,offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.
文摘Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.
文摘Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of preconception care. Therefore, the aim of this study was to establish the provision of preconception care by midwives, nurses and doctors at Ndola Teaching Hospital in Zambia. Methods: A concurrent embedded mixed methodology utilising a descriptive explorative study design, where 107 respondents were randomly selected using the lottery technique for quantitative part and two focused group discussions for qualitative part of the study was used. A self-administered questionnaire was used to collect quantitative data and a focus group discussion guide was used for the focus group discussions. Statistical Package of Social Sciences version 26 with significance set at 0.05 and at 95% confidence level and thematic analysis were used for data analysis. Results: 75% of the respondents in this study were not providing preconception care and only 25% of respondents were providing preconception care;however, this was provided randomly because there were no guidelines to follow. Among the respondents, 81.3% had medium knowledge, 70.1% had good practices and 92.5% had positive attitudes towards preconception care. Further analysis showed that the association between preconception care and knowledge, practices and attitudes was not statistically significant (p = values 0.336;0.344;1.000 respectively). Multivariate logistic regression revealed that participants with high knowledge were five times more likely to provide preconception care (OR = 5.00, CI = 0.42 - 59.7, P = 0.203). Generally, all the participants acknowledged that preconception care was an important package that could prevent maternal and child morbidities and mortalities. Conclusions: The study revealed that most of the respondents were not providing preconception care. Provision of preconception was done by a small fraction of the respondents and it was done in an unorderly manner due to lack of set standards and guidelines. Despite medium levels of knowledge and generally good practices and positive attitudes towards preconception care, its random provision indicates a need for established standards to enhance maternal and child health outcomes.
文摘Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.
文摘Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.
文摘In the last decade, the long-term survival among people living with HIV (PLHIV) has significantly improved. This is accompanied by an increased burden of non-communicable diseases such as hypertension due to the combined effect of the aging population and the metabolic effect of the Human Immuno-deficiency Virus (HIV) virion and antiretroviral therapy. This study aims to assess the prevalence and factors associated with hypertension among people living with HIV in three large health facilities in Nasarawa State, Nigeria. A descriptive cross-sectional study employed a multistage sampling technique to select 309 adults with HIV, 18 years and above, receiving HIV care in three large health facilities in Nasarawa State. The outcome variable was the participants’ self-reported history of hypertension, confirmed through a positive history of hypertension treatment. Exposure variables included the participant’s socio-demographic characteristics, lifestyle factors, and HIV care and treatment history. Data were presented using frequency tables. Factors associated with hypertension were assessed using binary logistic regression at a 0.05 level of statistical significance. A total of 309 adults living with HIV were sampled. A larger percentage of the participants were married 228 (73.8%), female, 191 (61.8%), within the age group 41 - 50 years, 141 (45.6%). Most of the participants had no family history of hypertension, 188 (60.8%). The prevalence of self-reported hypertension was 11.0% (34/309). Factors associated with hypertension at the bivariate level were age group 21 - 30 years, 41 - 50 years, being widow/widower, divorced, retired from employment or with family history of hypertension. Only participants age group 31 - 40 years [Adjusted Odd Ratio (AOR): 0.18, 95%CI: 0.04 - 0.91, p = 0.04] and family history of hypertension [(AOR): 83.44, 95%CI: 15.75 - 442.11, p < 0.01] were found to predict hypertension among the study participants after adjusting for confounders. In conclusion, Hypertension remains a public health issue among PLHIV. Factors associated with hypertension among PLHIV include age and family history of hypertension. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.
文摘Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.
