The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods t...The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.展开更多
Background: 25% of all people requiring surgical care are not able to access it due to its high cost. These people stand a high risk of preventable severe morbidity and mortality due to poor prognosis of surgically co...Background: 25% of all people requiring surgical care are not able to access it due to its high cost. These people stand a high risk of preventable severe morbidity and mortality due to poor prognosis of surgically correctable illnesses. Ambulatory surgical care services are significantly cheaper than orthodox surgical care and have become very relevant in this time and age where health conditions that can only be treated with surgical intervention are on the rise. The acceptability of ambulatory surgical care services will determine how this model increases universal health coverage. Objective: To assess the acceptability of ambulatory surgical services and its predictors among residents of Budondo Sub-County—Jinja district. Methods: The study was cross-sectional targeting 371 household heads in Budondo Sub-County, which was stratified by parish, with villages in each randomly sampled. Systematic random sampling was used to sample households and households therein were purposively sampled. Structured interviews and questionnaires were the data collection techniques, and data was analyzed in SPSS version 25 using descriptive statistics and a binomial logit model. Results: The level of acceptability of ambulatory surgical care services among residents of Budondo Sub-County was found to be near-universal, at 96.5%. The odds of accepting ambulatory surgical care were least among household heads who agreed that surgery done in a hospital would be cheaper than surgery done at community level (aOR = 0.174 [CI = 0.055 - 0.553]), those who had health insurance (aOR = 0.105 [95% CI = 0.030 - 0.371]), and household heads who were covered with private health insurance (aOR = 0.078 [95% CI = 0.008 - 0.792]). Acceptability of ASC was higher among household heads who agreed that they would trust ambulatory surgical centers with their life were more likely to accept ambulatory surgical care (aOR = 1.124, [95% CI = 1.122 - 3.218], P = 0.000), and household heads from households that had less than five members with surgery history were twice as likely to accept ambulatory surgical care (aOR = 2.431 [95% CI = 1.122 - 5.898], P = 0.000). Conclusion: Acceptability of ambulatory surgical care services among residents of Budondo Sub-County is high, and near-universal. It is mainly predicted by intrapersonal correlates and to a small extent by socio-demographic characteristics, with the implication that the administration of Global Surgical Initiatives in Kyabirwa ought to focus on modifying or uphold the intrapersonal characteristics found to be antagonists and protagonists of acceptability, respectively.展开更多
Introduction: Ambulatory Blood Pressure Measurement (ABPM) is a non- invasive examination recommended for subjects at high cardiovascular risk, and those requiring a nocturnal drop in BP such as elderly and obese...Introduction: Ambulatory Blood Pressure Measurement (ABPM) is a non- invasive examination recommended for subjects at high cardiovascular risk, and those requiring a nocturnal drop in BP such as elderly and obese subjects, those with secondary hypertension or resistant, diabetics, subjects with metabolic syndrome or sleep apnea syndrome. The objective of this study was to evaluate the contribution of ABPM in the diagnosis and evaluation of the level of control of hypertension under treatment at the Bel Air international clinic. Materials and Methods: This is a retrospective, cross-sectional and descriptive study, carried out at the Bel Air International Clinic in Conakry (Guinea) between January 2019 and November 30, 2022. It included a consecutive series of 180 consenting patients recruited through an ambulatory measurement of 24-hour blood pressure from a FUGADA brand device. Results: We collected 180 patients, with a male predominance (sex-ratio M/F = 2.46). The mean age of the patients was 48.48 ± 14.23 years. The most represented age group was that of 32 to 42 years with 50 cases (27.8%) followed by that of 43 to 52 years with 42 cases or 23.3%. The indication was for diagnostic purposes in 106 cases 58.9%, the therapeutic evaluation in 58 patients (32.2%). The examination was prescribed by a cardiologist in 98 cases (54.4%), a general practitioner in 71 cases (39.4%), a neurologist in 11 cases (6.1%). In the therapeutic evaluation, high blood pressure was controlled in 24 patients (13.3%) and uncontrolled in 34 cases (18.9%). In the diagnostic indication, high blood pressure was confirmed in 79 cases (43.9%) with a statistically significant link (Chi2</sup> = 4.57 and p-value = 0.032). The nycthemeral mean was 187.27 ± 26.22 mmHg for systolic blood pressure (SBP) and 110.37 ± 19.06 mmHg for diastolic blood pressure (DBP), during the day, 151.64 ± 21.45 mmHg for SBP and 71.59 ± 8.67 mmHg for diastolic blood pressure. During the study 65 patients (36.1%) were identified as dippers and 115 patients (63.9%) were no-dipping. The antihypertensive protocol used was monotherapy in 68 cases (37.8%), dual therapy in 46 cases (25.6%), triple therapy in 17 cases (9.4%). However 39 patients or 21.7% were not taking any antihypertensive. Conclusion: This preliminary study, despite the modest sample size, showed the importance of ABPM as a tool for diagnosis, monitoring of hypertensive patients and therapeutic adaptation. A large-scale national study would be necessary for the rational use of ambulatory blood pressure measurement in our context in order to improve the management of hypertensive patients.展开更多
Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performin...Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy(SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC( n = 49) or LC( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time(46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC;P < 0.001). As compared with LC, SILC was associated with lower total costs(8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB;P < 0.001) and better cosmetic satisfaction(4.94 ±0.24 vs. 4.74 ± 0.54;P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.展开更多
Over the past decade,there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases,including inflammatory bowel disease.Inflammatory bowel disease is a complex,chro...Over the past decade,there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases,including inflammatory bowel disease.Inflammatory bowel disease is a complex,chronic condition with associated morbidity,health care costs,and reductions in quality of life.The condition is managed primarily in the outpatient setting.The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity,the use of steroid-sparing agents,screening prior to anti-tumor necrosis factor therapy,and monitoring thiopurine therapy.This review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs,quality improvement frameworks,collaborative efforts in quality improvement,and the use of healthcare information technology.展开更多
Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination ther...Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.展开更多
A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,doub...A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.展开更多
This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the ...This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure(BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients' BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular(CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different agegroups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.展开更多
Introduction: Today, regional anesthetics are frequently used in combination with general anesthesia. The purpose of two different techniques is to attain distinct goals. We believed that the use of PNB with the minim...Introduction: Today, regional anesthetics are frequently used in combination with general anesthesia. The purpose of two different techniques is to attain distinct goals. We believed that the use of PNB with the minimization of GA in the ambulatory setting would result in a decreased opioid requirement and subsequently fewer treatment-related side effects, more awake and pain free patients and shorter PACU stays and earlier discharges when compared with general anesthesia alone. Methods: Prior to the start of this retrospective chart review, IRB approval was obtained. Patient’s charts were selected based on the following criteria: The control group had a general anesthetic (GA) and did not have a PNB, and the experimental group (PNB/GA) had a PNB and a general anesthetic. Our primary endpoints were PACU length of stay, pain scores, use of opioids and uses of anti-emetics. Results: We found that patient with blocks used less analgesic in the PACU, 3.97 mg vs. 1.39 mg (morphine equivalents). They also appeared to use less antiemetic drugs: 14/19 (patient s without PNB) vs. 7/18. Additionally, the patients that received a block had a statistically shorter PACU stay 107 min vs. 163 min. Conclusion: Patients that did not receive PNB had a significantly longer PACU stay. Additionally the data suggest that the use of PNB’s reduces the use of post-op narcotics, which may be related to the lower use of postoperative antiemetic drugs observed.展开更多
Objective:To study clinical significance of early postinfarctionischemia by ambulatory electrocardiographic monitoring(AEM).Methods:There were 64 petients with acute myocardial infarction(AMI).43 males,21 females,with...Objective:To study clinical significance of early postinfarctionischemia by ambulatory electrocardiographic monitoring(AEM).Methods:There were 64 petients with acute myocardial infarction(AMI).43 males,21 females,with a mean age of 61 years.Among of them,31 were anteriormyocardial infarction(MI),26 were inferior HI,7 were HI with botbanterior and inferior,All patlents were contintinueouslyonitored for5-12 days,The judging criteria were①ST segment depressed≥0.1andlasted for≥1 minute②The time interval between two ischemia attacks】1 minute.Results:Of all patients,46 showed postinfarction ischemia(PII)(72%),17 of them with symptom of postinfarction angina(PIA)(37%),29 of them without any symptom(63%).The incidence of PII within a weekafter infarction is 83%.These patients’incidence of arrhythimia,heartfallure,and cardiogenic shock are 90.24%,68.29%,and 19.51% respective-ly,which are much higher than that of those without PII attack.Discussion:The occurrence of PIA indicates relapsing myocardialischemia,and coronary angiography has confirmed a great degree ofstenosis with coronary artery.The exist of PII is one of theIndependent dan factors of bad prognosis of coronary heartdisease.It has been confirmed by other articles that ischemis mayexist whether PIA occurs or not,and the ircidence of ischemia withoutsymptom is higher,having the same result with this one.The depressionof ST segment can sensltively show ischemia So we must pay attentionto the change of ST segment in early stage of AMI.By AEM,we can findthat PII has different appearances and incidence with differentinfarction position and infarction range,and its occurrence has timedistribution,part of them are related to the activities of patients.Ischemia occurs more frequently in patients with anterior HI thanthose with inferior MI.The more extensive infarction,the higherincidence of ischemia,and the incidence of all kinds of complicationsand the mortality rate are higher in those with PII than those withoutit.Weiner D.A etc.also had similar reports.So we must strengthen themonitoring to the patients with PII to lay out individual cure planaccording to different attack characteristics,when necessary,we shouldtake coronary angiography to make PTCA or CABG.展开更多
BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevof...BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.展开更多
Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, wi...Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.展开更多
Objectives: To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including ...Objectives: To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers;however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.展开更多
Management of hypertension (HTN) largely relies on proper and accurate measurement of blood pressure (BP). Even following the criteria for HTN diagnosis defined in the Fourth report on high BP in children and adolesce...Management of hypertension (HTN) largely relies on proper and accurate measurement of blood pressure (BP). Even following the criteria for HTN diagnosis defined in the Fourth report on high BP in children and adolescents, inaccurate diagnosis and misdiagnosis can occur with white coat effect and masked HTN. The use of Ambulatory Blood Pressure Monitoring (ABPM) has been increasing in pediatrics in the last 20 years. The main use of ABPM is to differentiate between sustained HTN and white coat HTN in patients who have elevated casual BP measurements and to detect masked HTN in high risk patients. ABPM is most useful in patients with casual BP within 20% of the 95th percentile for age, gender, and height. This report will highlight the use of ABPM in the evaluation of elevated BP and management of HTN in pediatrics. The discussion includes a review of various non-invasive BP measuring techniques, a description of ABPM and ABPM-unique data and diagnoses, updated ABPM clinical data more specific to pediatrics, its use in HTN clinical trials, and future outlook and direction of ABPM in pediatrics.展开更多
Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in amb...Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.展开更多
OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider com...OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the morning because of the template. After the event, the total time in clinic did not change however the variability in time between and among each station decreased in variance. We informed the staff of these findings so that they could take responsibility for their part in the process. The atmosphere in clinic changed dramatically and the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results, got the staff engaged in the process, and provided a way for the patients to see the efforts made by staff to improve.展开更多
Background: Hypertension is a major public health concern in Burkina Faso. Its management relies on in-office medical setting blood pressure monitoring which is known to be an imperfect diagnosis tool. Objective: This...Background: Hypertension is a major public health concern in Burkina Faso. Its management relies on in-office medical setting blood pressure monitoring which is known to be an imperfect diagnosis tool. Objective: This study aims to assess the contribution of ambulatory blood pressure monitoring in the management of hypertension at Blaise Compaoré University Hospital. Methods: A monocentric descriptive retrospective study was conducted in the cardiology outpatient unit of Blaise Compaoré University Hospital. Patients aged at least 18 years who underwent ambulatory blood pressure monitoring between March 2013 and June 2015 were enrolled. Hypertension was defined as follows: average blood pressure over 24 hours > 130/80 mmHg, or diurnal blood pressure > 135/85 mmHg, or nocturnal blood pressure >120/70 mmHg. Data were analyzed using the SPSS 20.0 software. The threshold for significance was set at 5% for a validity interval at 95%. Chi square test was used for?the statistical analysis. Results: A total of 122 patients were enrolled. The main reasons for ambulatory monitoring were the evaluation of hypertensive therapy (51.6%) and the diagnosis confirmation (39.3%). The results of the ambulatory monitoring found 61.4% of the patients with hypertension and 37.7% with normal blood pressure. A treatment adjustment was made for 36.1% of the patients;an initiation of antihypertensive therapy was undertaken for 24.6%, an abstention from drug therapy was recommended?for 23.8%,?and the pursuit of previous treatment for 13.1% of the patients. Conclusion: Ambulatory blood pressure monitoring should be used more often in order to optimize the management of hypertension in our current practice.展开更多
Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its compo...Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its components have allowed us to obtain lengthier recordings in an ambulatory setting. We report on 261 ambulatory electroencephalograms performed consecutively in the two year period of 2011 and 2012 in a busy neurology and neuropsychiatry practice with predominantly geriatric patient population. 23% of these patients had abnormal AEEGs demonstrating clear-cut epileptogenic discharges. The role of these findings in clinical practice, especially in geriatric and psychiatric populations is discussed.展开更多
Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its compo...Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its components have allowed us to obtain lengthier recordings in an ambulatory setting. We report on 261 ambulatory electroencephalograms performed consecutively in the two year period of 2011 and 2012 in a busy neurology and neuropsychiatry practice with predominantly geriatric patient population. 23% of these patients had abnormal AEEGs demonstrating clear-cut epileptogenic discharges. The role of these findings in clinical practice, especially in geriatric and psychiatric populations is discussed.展开更多
<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the e...<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.展开更多
文摘The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.
文摘Background: 25% of all people requiring surgical care are not able to access it due to its high cost. These people stand a high risk of preventable severe morbidity and mortality due to poor prognosis of surgically correctable illnesses. Ambulatory surgical care services are significantly cheaper than orthodox surgical care and have become very relevant in this time and age where health conditions that can only be treated with surgical intervention are on the rise. The acceptability of ambulatory surgical care services will determine how this model increases universal health coverage. Objective: To assess the acceptability of ambulatory surgical services and its predictors among residents of Budondo Sub-County—Jinja district. Methods: The study was cross-sectional targeting 371 household heads in Budondo Sub-County, which was stratified by parish, with villages in each randomly sampled. Systematic random sampling was used to sample households and households therein were purposively sampled. Structured interviews and questionnaires were the data collection techniques, and data was analyzed in SPSS version 25 using descriptive statistics and a binomial logit model. Results: The level of acceptability of ambulatory surgical care services among residents of Budondo Sub-County was found to be near-universal, at 96.5%. The odds of accepting ambulatory surgical care were least among household heads who agreed that surgery done in a hospital would be cheaper than surgery done at community level (aOR = 0.174 [CI = 0.055 - 0.553]), those who had health insurance (aOR = 0.105 [95% CI = 0.030 - 0.371]), and household heads who were covered with private health insurance (aOR = 0.078 [95% CI = 0.008 - 0.792]). Acceptability of ASC was higher among household heads who agreed that they would trust ambulatory surgical centers with their life were more likely to accept ambulatory surgical care (aOR = 1.124, [95% CI = 1.122 - 3.218], P = 0.000), and household heads from households that had less than five members with surgery history were twice as likely to accept ambulatory surgical care (aOR = 2.431 [95% CI = 1.122 - 5.898], P = 0.000). Conclusion: Acceptability of ambulatory surgical care services among residents of Budondo Sub-County is high, and near-universal. It is mainly predicted by intrapersonal correlates and to a small extent by socio-demographic characteristics, with the implication that the administration of Global Surgical Initiatives in Kyabirwa ought to focus on modifying or uphold the intrapersonal characteristics found to be antagonists and protagonists of acceptability, respectively.
文摘Introduction: Ambulatory Blood Pressure Measurement (ABPM) is a non- invasive examination recommended for subjects at high cardiovascular risk, and those requiring a nocturnal drop in BP such as elderly and obese subjects, those with secondary hypertension or resistant, diabetics, subjects with metabolic syndrome or sleep apnea syndrome. The objective of this study was to evaluate the contribution of ABPM in the diagnosis and evaluation of the level of control of hypertension under treatment at the Bel Air international clinic. Materials and Methods: This is a retrospective, cross-sectional and descriptive study, carried out at the Bel Air International Clinic in Conakry (Guinea) between January 2019 and November 30, 2022. It included a consecutive series of 180 consenting patients recruited through an ambulatory measurement of 24-hour blood pressure from a FUGADA brand device. Results: We collected 180 patients, with a male predominance (sex-ratio M/F = 2.46). The mean age of the patients was 48.48 ± 14.23 years. The most represented age group was that of 32 to 42 years with 50 cases (27.8%) followed by that of 43 to 52 years with 42 cases or 23.3%. The indication was for diagnostic purposes in 106 cases 58.9%, the therapeutic evaluation in 58 patients (32.2%). The examination was prescribed by a cardiologist in 98 cases (54.4%), a general practitioner in 71 cases (39.4%), a neurologist in 11 cases (6.1%). In the therapeutic evaluation, high blood pressure was controlled in 24 patients (13.3%) and uncontrolled in 34 cases (18.9%). In the diagnostic indication, high blood pressure was confirmed in 79 cases (43.9%) with a statistically significant link (Chi2</sup> = 4.57 and p-value = 0.032). The nycthemeral mean was 187.27 ± 26.22 mmHg for systolic blood pressure (SBP) and 110.37 ± 19.06 mmHg for diastolic blood pressure (DBP), during the day, 151.64 ± 21.45 mmHg for SBP and 71.59 ± 8.67 mmHg for diastolic blood pressure. During the study 65 patients (36.1%) were identified as dippers and 115 patients (63.9%) were no-dipping. The antihypertensive protocol used was monotherapy in 68 cases (37.8%), dual therapy in 46 cases (25.6%), triple therapy in 17 cases (9.4%). However 39 patients or 21.7% were not taking any antihypertensive. Conclusion: This preliminary study, despite the modest sample size, showed the importance of ABPM as a tool for diagnosis, monitoring of hypertensive patients and therapeutic adaptation. A large-scale national study would be necessary for the rational use of ambulatory blood pressure measurement in our context in order to improve the management of hypertensive patients.
基金supported by a grant from the Subject of Shanghai Municipal Commission of Health and Family Planning(20124355)
文摘Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy(SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC( n = 49) or LC( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time(46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC;P < 0.001). As compared with LC, SILC was associated with lower total costs(8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB;P < 0.001) and better cosmetic satisfaction(4.94 ±0.24 vs. 4.74 ± 0.54;P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
文摘Over the past decade,there has been increasing focus on improving the quality of healthcare delivered to patients with chronic diseases,including inflammatory bowel disease.Inflammatory bowel disease is a complex,chronic condition with associated morbidity,health care costs,and reductions in quality of life.The condition is managed primarily in the outpatient setting.The delivery of high quality of care is suboptimal in several ambulatory inflammatory bowel disease domains including objective assessments of disease activity,the use of steroid-sparing agents,screening prior to anti-tumor necrosis factor therapy,and monitoring thiopurine therapy.This review outlines these gaps in performance and provides potential initiatives aimed at improvement including reimbursement programs,quality improvement frameworks,collaborative efforts in quality improvement,and the use of healthcare information technology.
基金supported by a grant from the Chinese Ministry of Sciences and Technology (2016YFC1300100)
文摘Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.
文摘A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.
文摘This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure(BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients' BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular(CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different agegroups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.
文摘Introduction: Today, regional anesthetics are frequently used in combination with general anesthesia. The purpose of two different techniques is to attain distinct goals. We believed that the use of PNB with the minimization of GA in the ambulatory setting would result in a decreased opioid requirement and subsequently fewer treatment-related side effects, more awake and pain free patients and shorter PACU stays and earlier discharges when compared with general anesthesia alone. Methods: Prior to the start of this retrospective chart review, IRB approval was obtained. Patient’s charts were selected based on the following criteria: The control group had a general anesthetic (GA) and did not have a PNB, and the experimental group (PNB/GA) had a PNB and a general anesthetic. Our primary endpoints were PACU length of stay, pain scores, use of opioids and uses of anti-emetics. Results: We found that patient with blocks used less analgesic in the PACU, 3.97 mg vs. 1.39 mg (morphine equivalents). They also appeared to use less antiemetic drugs: 14/19 (patient s without PNB) vs. 7/18. Additionally, the patients that received a block had a statistically shorter PACU stay 107 min vs. 163 min. Conclusion: Patients that did not receive PNB had a significantly longer PACU stay. Additionally the data suggest that the use of PNB’s reduces the use of post-op narcotics, which may be related to the lower use of postoperative antiemetic drugs observed.
文摘Objective:To study clinical significance of early postinfarctionischemia by ambulatory electrocardiographic monitoring(AEM).Methods:There were 64 petients with acute myocardial infarction(AMI).43 males,21 females,with a mean age of 61 years.Among of them,31 were anteriormyocardial infarction(MI),26 were inferior HI,7 were HI with botbanterior and inferior,All patlents were contintinueouslyonitored for5-12 days,The judging criteria were①ST segment depressed≥0.1andlasted for≥1 minute②The time interval between two ischemia attacks】1 minute.Results:Of all patients,46 showed postinfarction ischemia(PII)(72%),17 of them with symptom of postinfarction angina(PIA)(37%),29 of them without any symptom(63%).The incidence of PII within a weekafter infarction is 83%.These patients’incidence of arrhythimia,heartfallure,and cardiogenic shock are 90.24%,68.29%,and 19.51% respective-ly,which are much higher than that of those without PII attack.Discussion:The occurrence of PIA indicates relapsing myocardialischemia,and coronary angiography has confirmed a great degree ofstenosis with coronary artery.The exist of PII is one of theIndependent dan factors of bad prognosis of coronary heartdisease.It has been confirmed by other articles that ischemis mayexist whether PIA occurs or not,and the ircidence of ischemia withoutsymptom is higher,having the same result with this one.The depressionof ST segment can sensltively show ischemia So we must pay attentionto the change of ST segment in early stage of AMI.By AEM,we can findthat PII has different appearances and incidence with differentinfarction position and infarction range,and its occurrence has timedistribution,part of them are related to the activities of patients.Ischemia occurs more frequently in patients with anterior HI thanthose with inferior MI.The more extensive infarction,the higherincidence of ischemia,and the incidence of all kinds of complicationsand the mortality rate are higher in those with PII than those withoutit.Weiner D.A etc.also had similar reports.So we must strengthen themonitoring to the patients with PII to lay out individual cure planaccording to different attack characteristics,when necessary,we shouldtake coronary angiography to make PTCA or CABG.
文摘BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.
文摘Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.
文摘Objectives: To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers;however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.
文摘Management of hypertension (HTN) largely relies on proper and accurate measurement of blood pressure (BP). Even following the criteria for HTN diagnosis defined in the Fourth report on high BP in children and adolescents, inaccurate diagnosis and misdiagnosis can occur with white coat effect and masked HTN. The use of Ambulatory Blood Pressure Monitoring (ABPM) has been increasing in pediatrics in the last 20 years. The main use of ABPM is to differentiate between sustained HTN and white coat HTN in patients who have elevated casual BP measurements and to detect masked HTN in high risk patients. ABPM is most useful in patients with casual BP within 20% of the 95th percentile for age, gender, and height. This report will highlight the use of ABPM in the evaluation of elevated BP and management of HTN in pediatrics. The discussion includes a review of various non-invasive BP measuring techniques, a description of ABPM and ABPM-unique data and diagnoses, updated ABPM clinical data more specific to pediatrics, its use in HTN clinical trials, and future outlook and direction of ABPM in pediatrics.
文摘Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.
文摘OBJECTIVE: The ambulatory clinic was an important departmental problem. Providers hated working there and patients complained about the wait times there. It seemed there were equal numbers of patients and provider complaints. In the spirit of solving the problem, data was gathered, a LEAN intervention was planned, and data was collected. METHODS: We defined the service families in the clinic as registration, vital signs, provider or ultrasound visit, nursing visit, and registration for the return visit. We walked the Gemba engaging all the staff in the process. Many observations pointed to long waits between and among the five stations. In order to study the current state, time data was collected by attaching a sheet of paper to a folder that the patient would carry themselves to all the clinical steps. On the sheet of paper each station logged the time that patient appeared and the time the patient left their sight. Data was gathered each day and every day from October 2016 to the summer of 2017. The data was analyzed. Leadership met and identified value and waste in the process. A Kaizen event was scheduled after the first set of measurements engaging all the staff. After the data was thoroughly analyzed and digested, brainstorming occurred. Together we determined our future state. We created a vision and strategic goals to reach our future state. RESULTS: The data pre-Kaizen event showed that the process of arrival to leaving took 124 minutes. We discovered that not every patient passed through each station. We learned the patients were on time or early for their visit most of the time. The providers were late most of the time by 1 - 1.5 hours. We learned how long each station took from the patient’s point of view. There were no statistically significant differences between ultrasound and provider visits;there were no statistically significant differences between midwife and physician visits. Each day of the week was similar. The arrival rate was higher in the morning because of the template. After the event, the total time in clinic did not change however the variability in time between and among each station decreased in variance. We informed the staff of these findings so that they could take responsibility for their part in the process. The atmosphere in clinic changed dramatically and the complaints from both providers and patients stopped. CONCLUSION: LEAN management was used to improve the clinic. It yielded important results, got the staff engaged in the process, and provided a way for the patients to see the efforts made by staff to improve.
文摘Background: Hypertension is a major public health concern in Burkina Faso. Its management relies on in-office medical setting blood pressure monitoring which is known to be an imperfect diagnosis tool. Objective: This study aims to assess the contribution of ambulatory blood pressure monitoring in the management of hypertension at Blaise Compaoré University Hospital. Methods: A monocentric descriptive retrospective study was conducted in the cardiology outpatient unit of Blaise Compaoré University Hospital. Patients aged at least 18 years who underwent ambulatory blood pressure monitoring between March 2013 and June 2015 were enrolled. Hypertension was defined as follows: average blood pressure over 24 hours > 130/80 mmHg, or diurnal blood pressure > 135/85 mmHg, or nocturnal blood pressure >120/70 mmHg. Data were analyzed using the SPSS 20.0 software. The threshold for significance was set at 5% for a validity interval at 95%. Chi square test was used for?the statistical analysis. Results: A total of 122 patients were enrolled. The main reasons for ambulatory monitoring were the evaluation of hypertensive therapy (51.6%) and the diagnosis confirmation (39.3%). The results of the ambulatory monitoring found 61.4% of the patients with hypertension and 37.7% with normal blood pressure. A treatment adjustment was made for 36.1% of the patients;an initiation of antihypertensive therapy was undertaken for 24.6%, an abstention from drug therapy was recommended?for 23.8%,?and the pursuit of previous treatment for 13.1% of the patients. Conclusion: Ambulatory blood pressure monitoring should be used more often in order to optimize the management of hypertension in our current practice.
文摘Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its components have allowed us to obtain lengthier recordings in an ambulatory setting. We report on 261 ambulatory electroencephalograms performed consecutively in the two year period of 2011 and 2012 in a busy neurology and neuropsychiatry practice with predominantly geriatric patient population. 23% of these patients had abnormal AEEGs demonstrating clear-cut epileptogenic discharges. The role of these findings in clinical practice, especially in geriatric and psychiatric populations is discussed.
文摘Since the advent of imaging studies such as magnetic resonance imaging (MRI), the role of electroencephalograms (EEGs) has diminished. Simultaneously, computerized scanning and miniaturization of the EEG and its components have allowed us to obtain lengthier recordings in an ambulatory setting. We report on 261 ambulatory electroencephalograms performed consecutively in the two year period of 2011 and 2012 in a busy neurology and neuropsychiatry practice with predominantly geriatric patient population. 23% of these patients had abnormal AEEGs demonstrating clear-cut epileptogenic discharges. The role of these findings in clinical practice, especially in geriatric and psychiatric populations is discussed.
文摘<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.
