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11.
DS Keller RN Tahilramani JR Flores-Gonzalez S. Ibarra EM Haas 《Surgical endoscopy》2016,30(6):2192-2198
Background
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.Methods
Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.Results
Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (p = 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control; p < 0.01). The experimental group had significantly lower initial (p < 0.01) and final PACU pain scores (p = 0.04) and shorter LOS (3.0 vs. 4.1 days, p = 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.Conclusions
Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.12.
Identifying and integrating consumer perspectives in clinical practice guidelines on autosomal‐dominant polycystic kidney disease 下载免费PDF全文
Allison Tong PhD David J. Tunnicliffe MIPH Pamela Lopez‐Vargas MPH Andrew Mallett MBBS MMed FRACP Chirag Patel MBBS MD FRACP Judy Savige FRACP PhD Katrina Campbell PhD Manish Patel MBBS MMed PhD FRACS Michel C. Tchan MBBS PhD Stephen I Alexander MBBS MD MPH Vincent Lee MBBS FRACP Jonathan C. Craig BMChB PhD Robert Fassett MBBS PhD Gopala K. Rangan MBBS PhD 《Nephrology (Carlton, Vic.)》2016,21(2):122-132
13.
Li Ping Wong BSc MSc PhD Hui Meng Tan MBBS FRCS FRCS Wah Yun Low BA MSc PhD Chirk Jenn Ng MBBS MMed 《Journal of Men's Health》2008,5(4):356-365
BackgroundLittle is known about the practice, perceptions and experience of using traditional and complementary medicine (T/CM) for erection difficulties among Asian men.MethodsA total of 10,934 Asian men living in China (n = 2,055), Japan (n = 877), Korea (n = 2,000), Malaysia (n = 3,000) or Taiwan (n = 2,002) were recruited via random digit dialing, street interception and face-to-face interview in the Asian Men's Attitudes To Life Events and Sexuality (MALES) Phase I study. The Phase II study was comprised of a total of 1,286 men who experienced erection difficulties and who lived in China (n = 255), Japan (n = 228), Korea (n = 225), Malaysia (n = 380) or Taiwan (n = 228).ResultsUse of T/CM for erection difficulties (9.1%) was relatively low compared to conventional medicine (83.5%). Among those that seek help and treatment from T/CM, the majority were respondents from Malaysia, followed by respondents from China, whereas respondents from Japan and Korea ranked lowest. Use of a combination of alternative and conventional therapy was prevalent. Erection difficulty was amongst the highest in terms of preference of treatment seeking using traditional approaches after back pain, arthritis and gout. Overall outcome was expressed as ‘Partly satisfied’ with T/CM treatment for erection difficulties. The main reason that T/CM outweighs conventional medicine was because it was perceived that T/CM had fewer side effects than conventional medicine (56.1%). Users of T/CM were mostly middle-aged, married, employed, and perceived their health status and the severity of their erection dysfunction as moderate.ConclusionsThe findings help to identify the differences in practices and beliefs about T/CM among Asian countries and provide useful information to conventional practitioners about the alternative help- and treatment-seeking behaviors for erectile difficulties. 相似文献
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Murali Mahadevan FRACS Graeme van der Meer MBChB MMed Maayan Gruber MD Peter Reed DPhil Conor Jackson FRCS Colin Brown FRACS Nikki Mills FRACS Lesley J. Salkeld FRACS FRCSC Dip ABO Michel Neeff FRACS Jan Evans MBChB Brian Anderson PhD FANZCA FJFICM Colin Barber FRACS 《The Laryngoscope》2016,126(12):E416-E420