Preventing Surgical Delay and Cancellation with Patient-Centered Interventions

Delay and cancellation can significantly impact cost and outcomes among surgical patients. While the causes of delay and cancellation are not fully enumerated, possible reasons include delivery-related causes such as facility, equipment, and provider availability as well as patient-related issues such as readiness and health status. Despite limited research explaining patient-related causes, there are many studies that evaluate patient-centered interventions to decrease delay and cancellation. This article highlights patient-centered interventions including preoperative clinics, preoperative screening, and focused education that have been shown to reduce delay and cancellation. This information provides perianesthesia nurses and advanced practice nurses ideas to maximize their roles in improving efficiency by prevention of delay and cancellation. This article should also stimulate additional research to help better understand the causes and the role of the nurse in the implementation of evidence-based practice projects that use patient-centered interventions.     

腹腔镜不同术式治疗卵巢子宫内膜异位囊肿疗效及安全性的系统评价

目的系统评价腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及安全性。方法计算机检索The Cochrane Library、MEDLINE（1966～2011．11）、EMbase（1980～2011．11）、CNKI（1980—2011．11）、CBM（1980—2011．11）和WanFangData（1978～2011．11）,并手T检索相关文献,收集关于腹腔镜卵巢子宫内膜异位囊肿剥除术与凝同术比较治疗卵巢子宫内膜异位囊肿疗效及安全性的随机对照试验（RCT）,检索时限截至2011年11月。南2位研究者根据纳入与排除标准筛选文献、提取资料并评价质量后,采用RevMan5．1软件进行Meta分析。结果最终纳入5个研究。Meta分析结果显示：腹腔镜卵巢子宫内膜异位囊肿剥除术能降低子宫内膜异位症患者的痛经复发率[RR=0．29,95％CI（0．15,0．55）,P=0．0002]、性交痛复发率[RR=0．27,95％CI（0．09,0．77）,P=0．01]、非经期盆腔痛复发率[RR=0．19,95％CI（0．05,0．76）,P=0．02]、卵巢子宫内膜异位囊肿术后1、2年复发率[1年：RR=0．33,95％CI（0．15,O．74）,P=0．007;2年：RR=0．49,95％CI（0．26,0．95）,P=0．03]以及短期再次手术风险[RR=0．25,95％CI（0．07,O．85）,P=0．03],并增加不孕患者术后12个月和24个月的自然妊娠率[术后12个月：RR=2．82,95％CI（1．44,5．50）,P=0．002;术后24个月：RR=2．62,95％CI（1．47,4．68）,P=0．001]。此外,患者腹腔镜子宫内膜异位囊肿凝固术后6个月的卵巢储备功能优于剥除术[WMD=-4．26,95％CI（-5．98,-2．55）,P〈0．00001）,但两者术后5年的卵巢储备功能差异无统计学意义[WMD=0．27,95％CI（-0．18,0．73）,P=0．24]。结论腹腔镜子宫内膜异位囊肿剥除术能减少患者痛经、性交痛、非经期盆腔痛以及子宫内膜异位症的复发,还能降低短期再次手术的风险,并增加确诊为不孕患者的术后自然妊娠率。鉴于现有临床研究数量尚少,上述结论尚需开展更多高质量RCT加以验证。     

声衰减系数中的相位对消假象

本文首先分析了测量声衰减的信号接收装置特性。在此基础上,用直径0.06、0.5和1.4cm的三种压电接收换能器,在1～6MHz的频率范围内,测量超声在猪的心、肝、肌肉和脂肪组织中的声衰减系数,以研究这类换能器的相位对消效应对声衰减值造成的“假象”。经过实验证明:在测得的声衰减系数值中,确实潜在着压电换能器相位对消效应造成的“假象”此种效应对声衰减数据的影响,与接收换能器的面积大小相对应,同理论分析相一致:当使用小面积的换能器时,衰减系数与频率之间接近为线性关系。因此,要提高测量组织声衰减的精度,应采用小面积的压电换能器,或聚焦换能器。如果选用电声换能器、辐射力法和热学方法测量,可完全避免相位对消效应造成的“假象”。     

择期手术临时取消的原因分析及管理对策

目的分析择期手术临时取消的原因并探讨相应对策,以提高手术室工作效率和质量。方法对2010年1月至12月1 975例择期手术临时取消病例进行回顾性研究及相关因素分析。结果择期手术临时取消的主要因素有:疾病因素、术前准备不足、患者或家属拒绝手术和意外情况。结论医务人员应通过加强合并慢性疾病的术前处理,做好患者术前健康教育等措施降低择期手术临时取消率。     

Determining the State of Knowledge for Implementing the Universal Protocol Recommendations: An Integrative Review of the Literature

The purpose of this study was to determine the current state of knowledge concerning the implementation of the Joint Commission's Universal Protocol. We conducted an integrative review of the literature through a systematic search of the National Library of Medicine (ie, PubMed) database to identify empirical and theoretical documents that discussed the implementation process for the Universal Protocol. The current state of knowledge varies from facility to facility, and we noted significant trends, gaps, and areas of concern in the implementation process. Successful implementation of the Universal Protocol has the following elements: a multidisciplinary team approach, active staff/patient participation, supportive hospital administration/leadership, and active communication that promotes a healthy work environment.     

Effect of Surgeries on the Prognosis of 100 Patients with Malignant Glioma

In order to observe the effect of excision ranges on the prognosis of malignant glioma patients, we followed up 100 patients with malignant glioma who received operation between 1988 and 1993. And the results were as follows: 1 Materials and Methods 1.1 General material In the 100 subjects, 61 were males and 39 were females. The ages were from 12 to 72 with a mean age of 43.6 years. All tumors located in the cerebral hemisphere. Postoperation pathologic diagnosis showed that 57 cases were gl…     

术前访视对择期手术病人的效果评价

[目的]探讨术前访视对择期手术病人效果的影响。[方法]将60例择期手术病人随机分成术前访视组32例和对照组28例,访视组给予规范化术前访视,对照组采用普通访视。测两组病人术晨08:00入手术室时焦虑值及血压、心率并记录,术后3d回访病人,记录病人对访视的评价。[结果]病人焦虑值及术前收缩压、心率访视组均明显低于对照组,差异有统计学意义(P<0.05)。术后回访满意度访视组(90.62%)高于对照组(53.57%),但差异无统计学意义(P>0.05)。[结论]规范化术前访视可改善病人心理焦虑,维持血压、心率稳定,从而提高围术期护理质量,保证手术顺利进行。     

Less Common Gynecologic Malignancies: An Integrative Review

ObjectiveTo review current data on vaginal, vulvar, and fallopian tube cancers, including incidence, diagnosis, staging, risk reduction measures, and management.Data SourcesA review of retrieved articles dated 2006–2018 from PubMed.ConclusionEarly diagnosis and treatment of rare gynecologic cancers is dependent on a thorough history and examination. Of particular interest is the role of fallopian tube as the location of primary origin of ovarian and peritoneal cancers as well as the potential for vaccination prevention of vaginal and vulvar cancers.Implications for Nursing PracticeNurses in diverse roles should have an understanding of these rare tumor types to support assessment and early identification with their patients.     

个体化音乐对腹腔镜手术患者术前焦虑的影响

目的 探讨个体化音乐干预对腹腔镜手术患者术前焦虑的作用。方法 对60例全麻腹腔镜手术患者依据音乐背景评估,制定个体化音乐干预方案,于术前1-2h实施音乐干预,时间持续30min。比较不同性别、年龄、文化程度患者在干预前后焦虑的变化。结果 女性患者焦虑下降程度显著高于男性患者（P=0．04）;不同文化程度者焦虑下降程度经方差分析显示,大学文化组较小学文化组下降明显（F=4．36,P=0．02）;不同年龄之间焦虑下降程度无显著差异。结论 个体化音乐对不同腹腔镜手术患者减轻术前焦虑的作用存在差异,音乐干预对女性、文化程度较高者减轻焦虑的效果更显著。     

不同手术方式乳腺癌患者术后生活质量的调查

目的 了解不同手术方式对乳腺癌患者术后生活质量的影响,以期为乳腺癌手术方式的选择以及术后患者生活质量的提高提供依据.方法 2008年10月至2010年10月,采用乳腺癌患者生命质量测量表(functional assessment of cancer therapy-breast,FACT-B)对在温州市第八人民医院接受乳腺癌手术的患者进行了调查.结果 乳腺癌保乳术组和改良根治术组术后6个月、12个月的生活质量调查结果经比较,在生理状况、情感状况、功能状况、附加关注条目及生活质量总和方面,差异均有统计学意义(均P＜0.01),而社会/家庭状况方面差异无统计学意义(P＞0.05).结论 对早期乳腺癌患者行保乳手术能明显提高患者术后的生活质量.     

外科择期手术患者心理状态调查及心理护理

目的调查外科择期手术患者心理状态并探讨心理护理方法。方法采用贝克忧郁量表-Ⅱ(BDI-Ⅱ)评估340例择期手术患者心理状态,BDI-Ⅱ评分大于或等于14为抑郁症诊断标准。对明显抑郁或焦虑患者采取针对性心理护理。结果择期手术患者抑郁症发病率较高(达45%),且女性高于男性(P<0.05)。对明显心理障碍患者进行围术期心理护理获得明显效果。结论外科择期手术患者抑郁症发病率较高,针对性的心理护理有助于提高患者对手术的适应性,促进术后康复。     

动机性访谈在癌症择期手术患者中的应用

目的探讨动机性访谈(MI)在癌症择期手术患者中的应用效果。方法对100例癌症择期手术患者,随机分为对照组和实验组,各50例。对照组采用常规术前访视及健康教育。实验组采用MI方式进行心理干预。观察并评价两组手术患者术前的心理活动、手术配合程度及术后患者治疗的依从性及生命质量。结果两组术前的心理活动、手术配合程度、治疗依从性及生命质量比较有显著性差异(P<0.05)。结论对癌症择期手术患者采用MI的方式,可以改善患者术前的心理状态,提高手术患者术后治疗的依从性和生命质量。     

Safety and Efficacy of Dexmedetomidine in Breast Surgeries: A Systematic Review and Meta-Analysis

PurposePain control during and after breast surgery is still a challenging task. Dexmedetomidine (DEX) is considered as a sedative agent that is widely used perineurally or intravenously as an adjuvant in general anesthesia and critical care medicine practice. The aim of this study is to evaluate the efficacy of perineural DEX and intravenous (IV) DEX and their effects on postoperative complications in breast surgeries.DesignSystematic review and meta-analysis.MethodsThe present study systematically reviewed all identified randomized controlled trials for efficacy and safety of IV and perineural use of DEX in breast surgeries. Databases were searched for articles published before October 2019.FindingsTwelve trials were identified including 803 patients undergoing breast surgery. Although administration of IV DEX and its use with pectoral nerve (Pecs) block significantly postponed time for first analgesic request and decreased pain score at 1 and 12 hours after surgery, paravertebral use of DEX had no statistically significant effect. Pooled data about perineural DEX showed no significant effect on postoperative nausea and vomiting (PONV), whereas IV DEX significantly reduced PONV. Pooled analysis also showed that DEX administration did not significantly affect postoperative complications, such as postoperative itching, bradycardia, and pneumothorax in patients undergoing breast surgery.ConclusionsThe results showed that unlike paravertebral DEX, both DEX use with Pecs blocks and IV DEX were effective in control of postoperative pain in patients undergoing breast surgeries. Unlike perineural DEX, IV DEX significantly reduced PONV.