Implementation of guidelines for preoperative laboratory investigations in patients scheduled to undergo elective surgery

OBJECTIVE: To assess the impact on preoperative laboratory investigations in elective surgery after the implementation of guidelines for ordering such tests. DESIGN: A retrospective chart audit. SETTING: A university teaching hospital. PATIENTS: The charts of 903 patients who underwent an elective surgical procedure from each surgical specialty except cardiovascular and thoracic. INTERVENTIONS: Implementation of guidelines for preoperative laboratory investigations. MAIN OUTCOME MEASURES: Impact on the preoperative use of laboratory investigations after implementation of the guidelines as well as patient morbidity and mortality. RESULTS: The mean number of preoperative laboratory investigations done per patient decreased from 4.65 before implementation of the guidelines to 4.18 after (p < 0.001). There was no apparent adverse impact on patient morbidity or mortality. CONCLUSION: Implementation of guidelines for preoperative laboratory investigations for elective surgery resulted in a reduction in the number of tests without adverse impact on patient morbidity or mortality.     

Preoperative assessment criteria and patient teaching for ambulatory surgery patients

Today's trend is to have the surgical patient return to the comfort of his or her home rather than be admitted to the hospital for expensive nursing and medical care. The perioperative team must initially assess the patient's American Society of Anesthesiology status, anxiety level, food and drugs to which he or she may be allergic, and skin integrity; obtain a medical and surgical history and consent; review laboratory, electrocardiogram, and radiological results; and perform preoperative teaching (e.g., which medications to take or withhold preoperatively, when to withhold food and fluids) and postoperative teaching (e.g., catheter care, dressing changes). In addition, the nurse needs to anticipate and be prepared for medical emergencies such as airway management problems and malignant hyperthermia. The age of the patient (e.g., pediatric and geriatric age groups) and preoperative disease states and their severity also need to be recognized as they impact on the perioperative outcome. The assessment phase is one of the most important phases in the perioperative experience. Proper evaluation is the key to success for positive surgical outcomes. Given the time constraints in the ambulatory surgical setting, assessing and teaching the patient on the day of surgery is not feasible or appropriate. Reaching out to the patient a few days before surgery either in the patient's home, in the ambulatory surgery center, or by telephone is the ultimate goal.     

Forgiveness increases the likelihood of subsequent partner transgressions in marriage.

Despite a growing literature on the positive implications of forgiveness and recent efforts to promote forgiveness in marriage, there is reason to believe forgiveness could have yet-unknown negative implications. In particular, forgiveness may increase the likelihood that offenders will offend again by removing unwanted outcomes for those offenders (e.g., criticism, guilt, loneliness) that would otherwise discourage them from reoffending. Consistent with this possibility, the current 7-day-diary study revealed that newlywed spouses were more likely to report that their partners had engaged in a negative behavior on days after they had forgiven those partners for a negative behavior than on days after they had not forgiven those partners for a negative behavior. Interpersonal theories and interventions designed to treat and prevent relationship distress may benefit by acknowledging this potential cost of forgiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative analysis of diagnoses by the referring family physician and the hospital admission committee in ambulatory patients at an internal medicine department

The objectives of the present study were, as follows: 1. To what rate do the primary care doctors refer their patients to the regional internal medicine emergency department? 2. What sort of problems are the reasons of the referring? 3. To what extent are the opinions of the referring doctors confirmed or reviewed by the specialists? 4. What rate of the referred patients are admitted or discharged after the urgent consultations and-or interventions. 5. What kind of additional tests were used by the institutional caregivers in order to make accurate diagnoses? 6. What was the fate of the unaccepted patients? Data were collected in the patient document archive of the First Dept. of Medicine of the Albert Szent-Gy?rgyi Medical University, Szeged, Hungary. Each patients' referring notes and inpatient charts between September 15th, 1995 and January 15th, 1996 were studied in a retrospective way. Upon the results of the study, it was concluded, as follows: The primary care doctors referred their patients with right orientation diagnosis to the emergency department in 70% of the cases. 45.8% of the referred pts. were admitted to the internal inpatient ward. The agreement of the referring and discharge diagnoses was greater (85.7%) among the admitted patients as compared to the unaccepted ones (56.8%). 14% of the referred pts. were referred to other specialists by the internists. On the basis of the results the actual messages of the study for an under- and postgraduate medical teaching group, and for the health care politicians are discussed in the paper.     

Patient information issues in the ambulatory surgery setting

1. Patient compliance is a complex behavior that includes compliance with medication administration, lifestyles modifications, and all subsequent health care interventions. 2. Barriers to compliance should be identified and eliminated (if possible) to increase compliance. 3. Using multiple education techniques may be necessary if patient distractors are present.     

Prolonged exposure of Plasmodium falciparum to ciprofloxacin increases anti-malarial activity

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.     

The use of a video to convey preanesthetic information to patients undergoing ambulatory surgery

In a prospective, randomized, single-blind trial, we assessed the effectiveness of a preoperative video as a source of additional patient information before ambulatory surgery. One hundred twenty-seven patients were allocated to either treatment (video) or control (nonvideo) groups. Of the 127, 17 (13%) patients correctly answered all process, risk, and misconception statements using a questionnaire. Overall, the video group was 2-16 times more likely to recall all knowledge questions correctly than the nonvideo group after adjusting for previous general anesthesia experience, state (how one feels at the moment), and trait (how one generally feels) anxiety levels (relative risk 6.36, 95% confidence interval 2.01-15.82). The predictors of correct risk knowledge were those who had a video intervention (relative risk 7.12, 95% confidence interval 3.70 to 10.07) and low trait anxiety scores (relative risk 5.88, 95% confidence interval 1.69 to 25.00). A video could be an important additional component of the preoperative interview, but anesthesiologists will still need to provide patient-specific information. IMPLICATIONS: This study randomly allocated adults to see a video about anesthesia before scheduled ambulatory surgery. The video group had better recall of information. The video was a useful adjunct to routine preoperative consultations.     

Development of ambulatory surgery. An irreversible perspective

Whatever the social security system, the burden of health care costs is rising at an intolerable rate. It is however unacceptable to complain about a lack of resoures as long as the resources which are available are not used responsibly. Thanks to new technologies and drugs, ambulatory surgery, with its own adapted structures, can help to ensure responsible use of resources and satisfy patients, surgeons and allied health workers. Ambulatory surgery is currently expanding, especially in the U.S. (1990), where over 17 million operations are performed in an ambulatory mode, i.e. over 50% of all surgery. Hospitalization is avoided or shortened to a few hours whenever possible. Many uncomplicated surgical procedures, which are traditionally performed on an impatient basis under general anesthesia, are just as effectively and safely performed without admission to hospital.     

Noninvasive evaluation of patients with peripheral vascular disease scheduled to undergo surgery: dobutamine stress echocardiography versus myocardial perfusion imaging

The purpose of this investigation was to describe and compare two methods of recovery of atrophied skeletal muscle following short-term impaired physical mobility. An animal model was used to study morphologic adaptations of atrophied soleus and plantaris muscles to the effects of 7 days of hind-limb suspension (HS) followed by either sedentary recovery or run training during a 28-day recovery period. Significant atrophy, demonstrated by decreased mean fiber area (MFA, in square micrometers), occurred during the 7-day period of HS. During recovery, MFA returned to control values 14 days earlier in the sedentary compared with the trained groups. Runs training following short-term atrophy induced by HS did not result in the high levels of frank muscle damage and type IIC fibers previously reported following long-term (28-day) atrophy.     

Carotid disease in patients scheduled for coronary artery bypass: analysis of 678 patients

As the United States meets its obligation to provide social security benefits for a growing population of elderly people and as the U.S. economy increasingly is exposed to global competition, social policy for the elderly population cannot--and should not--be developed or assessed in isolation: It should be assessed in the context of changing society. This article discusses the growing imbalance in the economic conditions of elderly people and children. It argues that this growing imbalance should be considered a threat for the social and economic development of the United States. It encourages the leaders of the elderly population to get involved in the drive to channel more resources to children.     

First evaluation of a year of ambulatory surgery in urology

Day surgery in urology is in full growth actually. The present report is based on our first 120 patients. Low post-operative complication rate, patients' satisfaction and economical savings are the main factors for the important increase in this type of surgery.     

Organization and results of ambulatory surgery for inguinal hernia]

The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.     

Recurrence of inguinal hernia: ambulatory surgery under local anesthesia

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.     

Changes in the working status of pulmonary tuberculosis patients after the admission

We reported changes in the working status of pulmonary tuberculosis patients after the admission to our hospital. The age of patients ranged from 20 to 69 years old, and they were admitted to the 18th ward of our hospital from April 1991 to March 1993. We sent out the questionnaire to 198 patients, and the reply was sent back from 116 patients (Male 74, Female 42). Out of the 116 patients, we excluded the unemployed, the government employees, and self-employed workers. The remaining 76 patients were examined about their working status after admission, and the results were as follows: 2 patients lost their work, 11 patients retired from the work, 2 patients faced the drop of their position, and 3 patients had their salary reduced.