The impact of a structured preoperative protocol on day of surgery cancellations

Aims and objectives

To evaluate the impact of implementing an evidence‐based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties.

Background

Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care.

Design

Observational study with two study phases: before and after.

Methods

The cancellation data were collected from the hospital register from 1 September 2013–31 May 2014 (n = 591) and from September 2015–May 2016 (n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically.

Results

Cancellation rates varied between 1.6%–9.7% (in the first phase) and between 1.5%–7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found.

Conclusions

A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates.

Relevance to clinical practice

An evidence‐based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high‐quality care for surgical patients.     

MR-guided abdominal biopsy using a 1.5-Tesla closed system: a feasibility study

Background  

MR-guided biopsy may aid to obtain samples in cases which are not feasible with conventional US or CT guidance.     

Intra-abdominal pressure measurement using a modified nasogastric tube: Description and validation of a new technique

Objective  

This study assessed the accuracy of an intragastric method of measuring intra-abdominal pressure (IAP).     

Sepsis biomarkers: a review

Introduction  

Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy.     

Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report

Objective  

To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum.     

Self‐management programmes for people living with chronic obstructive pulmonary disease: a call for a reconceptualisation

Aims and objectives

To synthesise findings from previously published studies on the effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease.

Background

Self‐management is a widely valued concept to address contemporary issues of chronic health problems. Yet, findings of self‐management programmes for people with chronic obstructive pulmonary disease are indecisive.

Design

Literature review of (1) previously published systematic reviews and (2) an integrative literature review.

Method

Synthesis of findings from previously published systematic reviews (n = 4) of the effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease and an integrated review that was performed on papers published between January 2007–June 2012 (n = 9).

Results

Findings demonstrate that there are few studies on the effectiveness of self‐management programmes on people with chronic obstructive pulmonary disease despite more than a decade of research activities. Outcomes of the studies reveal some increase in health‐related quality of life and reduction in use of healthcare resources. The methodological approaches vary, and the sample size is primarily small. Families are not acknowledged. Features of patient‐centredness exist in self‐management programmes, particularly in the more recent articles.

Conclusions

The effectiveness of self‐management programmes for people with chronic obstructive pulmonary disease remains indecisive.

Relevance to clinical practice

A reconceptualisation of self‐management programmes is called for with attention to a family‐centred, holistic and relational care focusing on living with and minimising the handicapping consequences of the health problems in their entirety.     

Chest compressions versus ventilation plus chest compressions: a randomized trial in a pediatric asphyxial cardiac arrest animal model

Purpose  

To compare survival, oxygenation, ventilation, and hemodynamic variables achieved with chest compressions or ventilation plus chest compressions.     

Radiological findings of renal leiomyomas: a report of five surgically confirmed cases

Background  

To describe radiological features of renal leiomyomas.     

Health economics of a palliative care unit for terminal cancer patients: a retrospective cohort study

Purpose  

The objective of this study was to evaluate cost-reduction efficacy of a palliative care unit (PCU) by analyzing medical expenses of terminal cancer patients.     

Targeting Gelatinases with a Near-Infrared Fluorescent Cyclic His-Try-Gly-Phe Peptide

Purpose  

The purpose of the study is to synthesize and characterize near-infrared (NIR) fluorescence imaging probes targeted to gelatinases.     

Red blood cell distribution width as a predictor of atrial fibrillation

Background

Current evidence suggests that a higher red blood cell distribution width (RDW) may be associated with increased risk of atrial fibrillation (AF) development. Given that some controversial results have been published, we conducted a systematic review of the current literature along with a comprehensive meta‐analysis to evaluate the association between RDW and AF development.

Methods

We performed a systematic search of the literature using electronic databases (PubMed, Ovid, Embase, and Web of Science) to identify studies reporting on the association between RDW and AF development published until June 2016. We used both fix‐effects and random‐effects models to calculate the overall effect estimate. An I² > 50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity.

Results

A total of 12 studies involving 2721 participants were included in this meta‐analysis. The standardized mean difference in the RDW levels between patients with and those without AF development was 0.66 units (P < .05; 95% confidence interval 0.44‐0.88). A significant heterogeneity between the individual studies was observed (P < .05; I² = 80.4%). A significant association between the baseline RDW levels and AF occurrence or recurrence following cardiac procedure or surgery was evident (SMD: 0.61; 95% confidence interval 0.33‐0.88; P < .05) with significant heterogeneity across the studies (I² = 80.7%; P < .01).

Conclusions

Our comprehensive meta‐analysis suggests that higher levels of RDW are associated with an increased risk of AF in different populations.

     

Social competence in childhood brain tumor survivors: a comprehensive review

Purpose  

To review the literature investigating the social competence outcomes of child and adolescent survivors of brain tumors.     

Treatment of hypophosphatemia in the intensive care unit: a review

Introduction  

Currently no evidence-based guideline exists for the approach to hypophosphatemia in critically ill patients.     

Accurate image reconstruction using real C-arm data from a Circle-plus-arc trajectory

Objective  

Developing an efficient tool for accurate three-dimensional imaging from projections measured with C-arm systems.     

Contrast-enhanced ultrasound: a new method for TIPS follow-up

Purpose  

To determine the diagnostic value of contrast-enhanced ultrasound (CEUS) for the detection of TIPS (transjugular intrahepatic portosystemic shunt) complications.     

Transmission of 100-MHz-range ultrasound through a fused quartz fiber

Purpose  

This paper describes an investigation into direct observation of microscopic images of tissue using a thin acoustic wave guide.     

Expert consensus established around flexible,individualized migraine treatment utilizing a modified Delphi panel

Objective

To characterize treatment decision-making processes and formalize consensus regarding key factors headache specialists consider in treatment decisions for patients with migraine, considering novel therapies.

Background

Migraine therapies have long been subject to binary classification, acute versus preventive, due to limitations of available drugs. The emergence of novel therapies that can be used more flexibly creates an opportunity to rethink this binary classification. To determine the role of these novel therapies in treatment, it is critical to understand whether existing guidelines reflect clinical practice and to establish consensus around factors driving management.

Methods

A three-round modified Delphi process was conducted with migraine clinical experts. Round 1 consisted of an online questionnaire; Round 2 involved an online discussion of aggregated Round 1 results; and Round 3 allowed participants to revise Round 1 responses, incorporating Round 2 insights. Questions elicited likelihood ratings (0 = highly unlikely to 100 = highly likely), rankings, and estimates on treatment decision-making.

Results

Nineteen experts completed three Delphi rounds. Experts strongly agreed on definitions for “acute” (median = 100, inter-quartile range [IQR] = 5) and “preventive” treatment (median = 90, IQR = 15), but noted a need for treatment customization for patients (median = 100, IQR = 6). Experts noted certain aspects of guidelines may no longer apply based on established tolerability and efficacy of newer acute and preventive agents (median = 91, IQR = 17). Further, experts agreed on a treatment category referred to as “situational prevention” (or “short-term prevention”) for patients with reliable and predictable migraine triggers (median = 100, IQR = 10) or time-limited periods when headache avoidance is important (median = 100, IQR = 12).

Conclusions

Using the modified Delphi method, a panel of migraine experts identified the importance of customizing treatment for people with migraine and the utility of “situational prevention,” given the ability of new treatment options to meet this need and the potential to clinically identify patients and time periods when this approach would add value.     

Sclerotherapy of peritoneal inclusion cysts: a long-term evaluation study

Background  

This study was designed to evaluate the long-term results of sclerotherapy for the treatment of peritoneal inclusion cysts (PICs).     

Toward a clinical lumbar CAD: herniation diagnosis

Purpose  

A CAD system for lumbar disc degeneration and herniation based on clinical MR images can aid diagnostic decision-making provided the method is robust, efficient, and accurate.     

Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review

Purpose  

To review the predictive powers of SEPs in comatose children after acute brain injury.