术前访视对白内障手术患者焦虑状态的影响

目的 探讨术前访视对白内障手术患者焦虑的影响。方法 将101例白内障手术患者随机分为观察组（53例）和对照组（48例），观察组接受术前访视，对照组行常规术前准备及宣教，手术前1d及术晨采用状态-特质焦虑量表（STAI）测量两组患者焦虑状况，同时测量其血压、心率。结果 观察组术晨焦虑评分、收缩压、心率显著低于对照组（P〈0．05，P〈0．01），且血压及心率波动小。结论 术前访视能有效缓解白内障手术患者术前焦虑，减少血压、心率的波动，使患者以最佳状态接受手术。     

术前访视对白内障手术患者焦虑状态的影响

目的 探讨术前访视对白内障手术患者焦虑的影响.方法 将101例白内障手术患者随机分为观察组(53例)和对照组(48例),观察组接受术前访视,对照组行常规术前准备及宣教,手术前1 d及术晨采用状态-特质焦虑量表(STAI)测量两组患者焦虑状况,同时测量其血压、心率.结果 观察组术晨焦虑评分、收缩压、心率显著低于对照组(P＜0.05,P＜0.01),且血压及心率波动小.结论 术前访视能有效缓解白内障手术患者术前焦虑,减少血压、心率的波动,使患者以最佳状态接受手术.     

术前护理干预对手术患者身心状态的影响

目的 探讨术前护理干预对手术患者身心的影响。方法 将100例择期手术患者随机分为观察组与对照组各50例。对照组按手术常规护理；观察组除常规护理外，巡回护士于手术前1d进行术前访视、术日晨到病房迎接患者、入室后给患者戴上耳机欣赏选定的音乐30min。比较两组患者术前1d与术前焦虑程度、心率及血压的变化。结果 观察组患者术前SAS评分显著低于对照组（P〈0．01），且心率和血压稳定。结论 实施术前护理干预能有效减轻患者的应激反应，维持血流动力学的稳定，有利于手术的顺利进行。     

术前护理干预对手术患者身心状态的影响

目的 探讨术前护理干预对手术患者身心的影响.方法 将100例择期手术患者随机分为观察组与对照组各50例.对照组按手术常规护理;观察组除常规护理外,巡回护士于手术前1 d进行术前访视、术日晨到病房迎接患者、入室后给患者戴上耳机欣赏选定的音乐30 min.比较两组患者术前1 d与术前焦虑程度、心率及血压的变化.结果 观察组患者术前SAS评分显著低于对照组(P＜0.01),且心率和血压稳定.结论 实施术前护理干预能有效减轻患者的应激反应,维持血流动力学的稳定,有利于手术的顺利进行.     

术前针对性访视对减轻肝胆手术病人焦虑的分析

手术作为一种压力源，对病人及其家属来说是与生命和健康息息相关的重大事件。几乎所有的病人，都会有感受不同压力的表现和情绪变化，尤其是焦虑症状。是对于预期的心理威胁的一种情绪反应。随着手术日期的逐渐临近，病人对手术的恐惧与日俱增，甚至超过了对疾病的担心。     

术前访视对手术室护理工作的影响

目的:探讨术前访视对手术室护理工作的影响.方法:选择120例择期手术患者随机分为两组(实验组和对照组,n=60),实验组实施术前访问,对照组术前常规护理,不实施术前访视.结果:实验组患者的收缩压、心率、并发症发生率低于对照组(P＜0.05);对护理工作的满意率高于对照组(P＜0.05).结论:术前访视能显著提高手术的成功率,减轻患者的心理负担,降低术后并发症发生率,提高患者对护理工作的满意程度等.     

术前心理护理访视对子宫切除患者焦虑水平的影响

目的:探讨术前心理护理访视对子宫切除患者焦虑水平的影响.方法:选择首次接受手术,择期行子宫切除术患者90例,ASAⅠ或Ⅱ级,随机等分为3组.无访视组(A组):不进行术前访视;常规访视组(B组):术前一日下午进行简单术前护理访视;心理护理访视组(C组):按照心理护理方法进行术前访视.测量并记录术前一日8时,入室后即刻及镇静吸氧后的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和脉搏血氧饱和度(SpO2)值,并行焦虑视觉模拟评分(AVAT).结果:A组和B组入室后即刻的MAP、HR、RR和AVAT值均明显高于术前基础值及C组同时值(P＜0.05或P＜0.01).在镇静吸氧后,A组和B组的MAP、HR和RR值较入室后即刺均有明显降低(P＜0.05或P＜0.01),而三组的SpO2值则均有显著升高(P＜0.01).结论:术前心理护理访视能有效降低子宫切除术患者的术前焦虑水平,既提高了护理质量,又有利于麻醉和手术的安全顺利实施.     

学龄前期手术患儿的术前访视与干预模式探讨

目的探讨学龄前期手术患儿适宜的访视和术前干预模式。方法选取200例3～6岁择期手术患儿分为观察组与对照组各100例。对照组采用传统的术前1d手术访视,进入手术室后立即开始实施麻醉;观察组术前5d开始每天访视,通过游戏、图片等介绍手术室环境及麻醉前配合等方法,术前静脉穿刺采用无痛措施等。分别取术前1d、术前30min、麻醉前测量患儿的心率、呼吸、动脉压。结果两组不同时间心率、呼吸、动脉压比较,干预主效应均P<0.05。结论对学龄前期手术患儿行5d访视和综合术前干预有助于密切患儿与手术室护士的关系,维持其生命体征平稳,保证手术安全。     

Bariatric Surgery: Severity, Level of Control, and Time Required for Preoperative Asthma Control

Background

There is an increased prevalence of asthmatic, obese patients undergoing bariatric surgery. The objective of our study is to evaluate the severity, level of control, respiratory medication use, and time required for prebariatric surgery asthma control.

Methods

This is a prospective study in which 88 obese asthmatics were evaluated by a pulmonologist in two steps, prebariatric surgery. In the first step, patients were evaluated for severity, level of control, and respiratory medication in use, categorized as bronchodilators and corticosteroids. In the second step, the time required for asthma control between steps and appropriate respiratory medication was determined.

Results

Thirty-eight obese patients (43.2%) had intermittent asthma, 22 had mildly persistent (25.0%), 24 moderately persistent (27.3%), and 4 severely persistent (4.5%). There were 43 patients with controlled asthma (48.9%), 31 partly controlled (35.2%), and 14 uncontrolled (15.9%). The study sample showed a significant increase in bronchodilators in the first step and corticosteroids in the second step (p?≤?0.0001). Comparisons between steps showed significant differences with a reduction of bronchodilators and increase in corticosteroids in the second step (p?≤?0.0001). The mean time (days) required for asthma control between steps was 28.98?±?33.40 days, with significant differences between groups (p?≤?0.001).

Conclusions

In prebariatric surgery, there was a higher proportion of intermittent asthma and uncontrolled asthma, with asthma severity influencing the achievement of asthma control and the time required for surgical release.     

Preoperative Nutritional Interventions in Morbid Obesity: Impact on Body Weight, Energy Intake, and Eating Quality

Background

Although the benefits of preoperative weight loss and adequacy of dietary patterns in bariatric surgery is well-recognized, the nutritional strategies in the preoperative period have been scarcely investigated. We aimed to evaluate the impact of intensive and standard nutritional interventions on body weight, energy intake, and eating quality.

Methods

This is a retrospective study in which 32 patients undergoing intensive nutritional intervention, with low-calorie diet (10?kcal/kg) and biweekly visits, were pair-matched by age, sex, and body mass index with 32 patients under a standard nutritional intervention, based on a general dietary counseling. Twenty-four-hour food recall was used to assess energy intake and to derive healthy eating index (HEI). The follow-up preoperative period varied from 8 to 16?weeks.

Results

Weight loss was observed in 72?% of the patients from the intensive intervention group and 75?% of the patients from the standard intervention group. According to the mixed model analysis, time effect on weight loss in both groups was significant (P?=?0.0002); however, no difference was found between the intervention groups (P?=?0.71). The time effect was significant in both groups for energy intake reduction as well (P?<?0.0001), but no difference was found between the intervention groups (P?=?0.25). Improvement of eating quality was expressed by the nutrient score of the HEI that increased significantly overtime (P?=?0.02), also without distinction between the groups (P?=?0.61).

Conclusion

Both intensive and standard nutritional interventions promoted weight loss, energy intake reduction, and improvement of eating quality in morbidly obese patients during preoperative period.     

Impact of Preoperative Teaching on Surgical Option of Patients Qualifying for Bariatric Surgery

Background: During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic. Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative teaching on the patients' surgical option. Methods: All the candidates for bariatric surgery were submitted to preoperative teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session, with an additional possible answer: no surgery. Results: 297 consecutive patients with a BMI >35 kg/m² with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%) declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing bypass increased from 43% to 70%. Conclusions: Preoperative training provides an informed and better patient selection for bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier.     

Economic Impact of Preoperative Curettage before Mohs Micrographic Surgery for Basal Cell Carcinoma

BACKGROUND: The role of curettage before Mohs micrographic surgery for basal cell carcinoma (BCC) remains controversial. Preoperative curettage may allow the surgeon to better delineate the subclinical extensions of high-risk BCCs, thereby enabling a more precise first-stage excision around tumor-containing tissue. OBJECTIVE: To assess the economic impact of preoperative curettage for high-risk BCCs treated with Mohs micrographic surgery on patients, providers, and insurers. METHODS: Given the enormous variability in practice styles, it was estimated that the time required to complete a second stage of Mohs surgery was 25, 50, or 75% of that required to complete the first stage. New York City Medicare and Standard reimbursement rates were used to approximate the cost of an additional stage of Mohs surgery for high-risk BCCs. RESULTS: Assuming that preoperative curettage increases operative efficiency by reducing the number of required Mohs stages from 2 to 1, the time saved can be quantified. Thus, if the Mohs surgeon estimates that the time required to remove a second stage is 75% of that of the first stage, the time savings with preoperative curettage equals 75% of the duration of a one-stage Mohs surgery. Similarly, when a second stage requires 50 or 25% of the time needed to complete the first stage, the time saved equals 50 or 25% of the duration of a one-stage Mohs surgery. Reducing the number of stages from 2 to 1 saves insurers and privately paying patients approximately $250 and $500, respectively. CONCLUSIONS: Whether preoperative curettage can offer a more precise first-stage excision without compromising tissue conservation remains a subject of debate. Preoperative curettage may reduce the number of Mohs surgical stages required for tumor clearance, potentially shortening patient encounters and allowing surgeons to treat additional patients, while decreasing costs for patients and insurers.     

Impact of Adult Living Donor Liver Transplantation on Waiting Time Survival in Candidates Listed for Liver Transplantation

Studies comparing adult living donor liver transplantation to deceased donor liver transplantation have focused on post-transplant survival. Our aim was to focus on the impact of living donor liver transplant on waiting time mortality and overall mortality. We analyzed the affect of living donor liver transplantation on waiting time mortality and overall mortality (from listing until last follow up) in a cohort of 116 transplant candidates. Fifty-eight candidates who had individuals present as potential living donors (volunteer group) were matched by MELD score to 58 liver transplant candidates who did not have individuals present as a potential living donor (no volunteer group). Twenty-seven percent of candidates in the no volunteer group and 62% of candidates in the volunteer group underwent liver transplantation, p = 0.0003. One-year waiting list mortality for the volunteer group and no volunteer group was 10% and 20%, respectively, p = 0.03. Patient survival from the time of listing to last follow up was similar between the two groups. In our study group, living donor liver transplantation is associated with a higher rate of liver transplantation and lower waiting time mortality. In the era of living donor liver transplantation, estimates of patient survival should incorporate waiting time mortality.