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Enhanced recovery programme

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https://www.readbyqxmd.com/read/29124853/intracorporeal-robotic-assisted-radical-cystectomy-together-with-an-enhanced-recovery-programme-improves-postoperative-outcomes-by-aggregating-marginal-gains
#1
Wei Shen Tan, Mae-Yen Tan, Benjamin W Lamb, Ashwin Sridhar, Anna Mohammed, Hilary Baker, Senthil Nathan, Timothy Briggs, Melanie Tan, John D Kelly
OBJECTIVE: To assess the cumulative effect of an enhanced recovery after surgery (ERAS) pathway and a minimally invasive RARC with intracorporeal urinary diversion (iRARC) in comparison to open radical cystectomy (ORC) on hospital length of stay (LOS) and perioperative outcomes. MATERIALS & METHODS: Between Feb 2009 and Oct 2017, 304 radical cystectomy cases were performed at a single institution (54 ORC, 250 RARC). Data were prospectively collected. We identified 45 consecutive ORC cases performed without ERAS before the commencement of the RARC programme (Cohort A), 50 consecutive iRARC cases performed without ERAS (Cohort B) and 40 iRARC cases with ERAS (Cohort C)...
November 10, 2017: BJU International
https://www.readbyqxmd.com/read/29120930/enhanced-recovery-for-thoracic-surgery-in-the-elderly
#2
Stephen J Shepherd, Andrew A Klein, Guillermo Martinez
PURPOSE OF REVIEW: Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. RECENT FINDINGS: Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment...
November 7, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29111798/perioperative-medicine-a-new-model-of-care
#3
Lena Al-Shammari, Deborah Douglas, Geetha Gunaratnam, Chris Jones
The discipline of perioperative medicine provides a foundation for the consistent delivery of safe and good quality care to surgical patients. Its goals include the identification and optimal care of the high-risk surgical patient, fostering patient-centred decision making throughout the surgical perioperative pathway, and reducing unwarranted variation in practice. In turn, this should reduce preventable complications and improve patient satisfaction, long-term morbidity and survival. This review concludes a series of articles which have described the epidemiology of surgical disease, the growth in the objective means of risk assessment, and novel outcome measures...
November 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29081374/enhanced-recovery-after-surgery-for-pancreaticoduodenectomy-review-of-current-evidence-and-trends
#4
REVIEW
Xiequn Xu, Chaoji Zheng, Yupei Zhao, Weiyun Chen, Yuguang Huang
Pancreaticoduodenectomy (PD) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with PD by utilizing ERAS. Guidelines for perioperative care after PD were published in 2013, but these recommendations could even change in one year. The purpose of this review is to examine the current evidence for ERAS in preoperative, intraoperative and post-operative setting of care for PD patients and to propose ERAS evidence-based protocol for patients undergoing PD...
October 25, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29046917/effects-of-an-injectable-functionalized-self-assembling-nanopeptide-hydrogel-on-angiogenesis-and-neurogenesis-for-regeneration-of-the-central-nervous-system
#5
Tzu-Wei Wang, Kai-Chieh Chang, Liang-Hsin Chen, Shih-Yung Liao, Chia-Wei Yeh, Yung-Jen Chuang
Brain injury is a devastating medical condition and represents a major health problem. Tissue and organ reconstruction have been regarded as promising therapeutic strategies. Here, we propose a regenerative methodology focusing on the provision of functionalized nanopeptide scaffolds to facilitate angiogenesis and neurogenesis at the brain injury site. The peptide RADA16-SVVYGLR undergoes self-assembly to construct an interconnected network with intertwining nanofibers, and can be controlled to display various physicochemical properties by the adjustment of microenvironmental factors such as pH and ion concentration...
November 2, 2017: Nanoscale
https://www.readbyqxmd.com/read/29039944/3d-printed-microflow-injection-analysis-platform-for-online-magnetic-nanoparticle-sorptive-extraction-of-antimicrobials-in-biological-specimens-as-a-front-end-to-liquid-chromatographic-assays
#6
Han Wang, David J Cocovi-Solberg, Bin Hu, Manuel Miró
In this work, the concept of 3D-printed microflow injection (3D-μFI) embodying a dedicated multifunctional 3D-printed stator onto a rotary microvalve along with a mesofluidic sample preparation platform is proposed for the first time. A transparent 3D-printed stereolithographic mesofluidic chip device accommodating polyaniline (PANI) decorated magnetic nanoparticles (32.5 ± 3.8 mg) is harnessed to in-line sorptive microextraction as a front end to liquid chromatography with peak focusing. As a proof-of-concept application, the 3D-μFI assembly was resorted to matrix cleanup and automatic programmable-flow determination of organic emerging contaminants (4-hydroxybenzoate analogues and triclosan as antimicrobial model analytes) in human saliva and urine samples...
October 31, 2017: Analytical Chemistry
https://www.readbyqxmd.com/read/29022790/accelerated-discharge-within-72-hours-of-colorectal-cancer-resection-using-simple-discharge-criteria
#7
A Emmanuel, E Chohda, C Botfield, J Ellul
Introduction Short hospital stays and accelerated discharge within 72 hours following colorectal cancer resections have not been widely achieved. Series reporting on accelerated discharge involve heterogeneous patient populations and exclude important groups. Strict adherence to some discharge requirements may lead to delays in discharge. The aim of this study was to evaluate the safety and feasibility of accelerated discharge within 72 hours of all elective colorectal cancer resections using simple discharge criteria...
September 15, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28903814/academic-continuity-planning-in-higher-education
#8
Cheryl Regehr, Sioban Nelson, Angela Hildyard
Crisis planning in institutions of higher learning has focused largely on emergency management, physical safety and technology recovery. While these are clearly important, many aspects of planning for continuity have largely been ignored, including planning for the post-secondary education sector's core business, that is, the delivery of graduate and undergraduate academic programmes. Use of the term 'academic continuity' as a component of institutional planning is relatively new in higher education. Discussions on academic continuity have often centred on the use of technology-enhanced education and online teaching in the event of crisis or disaster affecting campuses...
January 1, 2017: Journal of Business Continuity & Emergency Planning
https://www.readbyqxmd.com/read/28898283/sustained-effectiveness-and-cost-effectiveness-of-the-healthy-activity-programme-a-brief-psychological-treatment-for-depression-delivered-by-lay-counsellors-in-primary-care-12-month-follow-up-of-a-randomised-controlled-trial
#9
RANDOMIZED CONTROLLED TRIAL
Benedict Weobong, Helen A Weiss, David McDaid, Daisy R Singla, Steven D Hollon, Abhijit Nadkarni, A-La Park, Bhargav Bhat, Basavraj Katti, Arpita Anand, Sona Dimidjian, Ricardo Araya, Michael King, Lakshmi Vijayakumar, G Terence Wilson, Richard Velleman, Betty R Kirkwood, Christopher G Fairburn, Vikram Patel
BACKGROUND: The Healthy Activity Programme (HAP), a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes. METHODS AND FINDINGS: Primary care attendees aged 18-65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9) were randomised to either HAP plus enhanced usual care (EUC) (n = 247) or EUC alone (n = 248), of whom 95% completed assessments at 3 months, and 91% at 12 months...
September 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28864707/patients-and-nurses-views-on-providing-psychological-support-within-cardiac-rehabilitation-programmes-a-qualitative-study
#10
Katrina M Turner, Rachel Winder, John L Campbell, David A Richards, Manish Gandhi, Chris M Dickens, Suzanne Richards
OBJECTIVE: To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. DESIGN: In-depth interviews analysed thematically. PARTICIPANTS: 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28859687/healthcare-professionals-views-of-the-enhanced-recovery-after-surgery-programme-a-qualitative-investigation
#11
Georgia Herbert, Eileen Sutton, Sorrel Burden, Stephen Lewis, Steve Thomas, Andy Ness, Charlotte Atkinson
BACKGROUND: The Enhanced Recovery After Surgery (ERAS) programme is an approach to the perioperative care of patients which aims to improve outcomes and speed up recovery after surgery. Although the evidence base appears strong for this programme, the implementation of ERAS has been slow. This study aimed to gain an understanding of the facilitating factors and challenges of implementing the programme with a view to providing additional contextual information to aid implementation. The study had a particular focus on the nutritional elements as these have been highlighted as important...
August 31, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28841893/the-role-of-nutritional-support-in-the-physical-and-functional-recovery-of-critically-ill-patients-a-narrative-review
#12
REVIEW
Danielle E Bear, Liesl Wandrag, Judith L Merriweather, Bronwen Connolly, Nicholas Hart, Michael P W Grocott
The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.This narrative review focuses specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery...
August 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28836493/developing-a-multidisciplinary-rehabilitation-package-following-hip-fracture-and-testing-in-a-randomised-feasibility-study-fracture-in-the-elderly-multidisciplinary-rehabilitation-femur
#13
Nefyn H Williams, Jessica L Roberts, Nafees Ud Din, Joanna M Charles, Nicola Totton, Michelle Williams, Kevin Mawdesley, Claire A Hawkes, Val Morrison, Andrew Lemmey, Rhiannon T Edwards, Zoe Hoare, Aaron W Pritchard, Robert T Woods, Swapna Alexander, Catherine Sackley, Pip Logan, Clare Wilkinson, Jo Rycroft-Malone
BACKGROUND: Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking. OBJECTIVES: To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation...
August 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28768427/enhanced-recovery-programmes-for-lower-limb-arthroplasty-in-the-uk
#14
N S Nagra, T W Hamilton, L Strickland, D W Murray, H Pandit
Introduction Enhanced recovery programmes (ERPs) reduce patient morbidity and mortality, and provide significant cost savings by reducing length of stay. Currently, no uniform ERP guidelines exist for lower limb arthroplasty in the UK. The aim of this study was to identify variations in ERPs and determine adherence to local policy. Methods Hospitals offering elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) (23 and 22 centres respectively) contributed details of their ERPs, and performed an audit (15 patients per centre) to assess compliance...
August 3, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28713467/quality-versus-quantity-debate-in-swimming-perceptions-and-training-practices-of-expert-swimming-coaches
#15
Frank J Nugent, Thomas M Comyns, Giles D Warrington
The debate over low-volume, high-intensity training versus high-volume, low-intensity training, commonly known as Quality versus Quantity, respectively, is a frequent topic of discussion among swimming coaches and academics. The aim of this study was to explore expert coaches' perceptions of quality and quantity coaching philosophies in competitive swimming and to investigate their current training practices. A purposeful sample of 11 expert swimming coaches was recruited for this study. The study was a mixed methods design and involved each coach participating in 1 semi-structured interview and completing 1 closed-ended questionnaire...
June 2017: Journal of Human Kinetics
https://www.readbyqxmd.com/read/28679348/implementing-enhanced-recovery-pathways-a-literature-review-with-realist-synthesis
#16
REVIEW
Astrid Coxon, Karina Nielsen, Jane Cross, Chris Fox
OBJECTIVES: Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. METHODS: Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy...
October 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28647727/patients-as-partners-in-enhanced-recovery-after-surgery-a-qualitative-patient-led-study
#17
Chelsia Gillis, Marlyn Gill, Nancy Marlett, Gail MacKean, Kathy GermAnn, Loreen Gilmour, Gregg Nelson, Tracy Wasylak, Susan Nguyen, Edamil Araujo, Sandra Zelinsky, Leah Gramlich
OBJECTIVES: Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. DESIGN: Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. SETTING: Five tertiary care centres in Alberta, Canada, following the ERAS programme...
June 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28640971/enhanced-recovery-programme-following-laparoscopic-colorectal-resection-for-elderly-patients
#18
Wei Gen Zeng, Meng Jia Liu, Zhi Xiang Zhou, Zhen Jun Wang
BACKGROUND: The aim of this study was to investigate the feasibility and safety of an enhanced recovery programme (ERP) in patients aged ≥75 years who undergo laparoscopic surgery for colorectal cancer. METHODS: Patients were divided into two groups according to perioperative management: the ERP group (Group A, n = 94) and the conventional perioperative care group (Group B, n = 157). The postoperative outcomes were compared between two groups. RESULTS: There were no differences in terms of age, gender, American Society of Anesthesiologists score, operative time or blood loss between two groups...
June 22, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28634646/the-role-of-robotics-in-the-invasive-management-of-bladder-cancer
#19
REVIEW
Pramit Khetrapal, Wei Shen Tan, Benjamin Lamb, Melanie Tan, Hilary Baker, James Thompson, Ashwin Sridhar, John D Kelly, Tim Briggs
Robot-assisted radical cystectomy (RARC) has been adopted widely in many centres, owed largely to the success of robot-assisted laparoscopic prostatectomy (RALP). It aims to replicate the oncological outcomes of open radical cystectomy (ORC), while providing a shorter recovery period. Despite this, previous RCTs have failed to show a benefit for RARC over ORC. These trials have compared extracorporeal RARC (eRARC) with ORC, which requires a further incision to mobilise the bowel for urinary reconstruction with an open technique...
August 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28623570/enhanced-recovery-protocols-in-total-joint-arthroplasty-a-review-of-the-literature-and-their-implementation
#20
REVIEW
A S Galbraith, E McGloughlin, J Cashman
BACKGROUND: During recent years, there has been an exponential demand for joint arthroplasty, which has coincided with the global economic recession. In response, the management of patients following arthroplasty is continuously evolving, with the average inpatient length of stay decreasing from weeks to days, and more recently, we have witnessed the development of "outpatient arthroplasty" as a novel concept which aims to address the high volume of patients. The reduction in length of stay has been made possible via implementation of "enhanced recovery programmes" encompassing each stage of the patient journey...
June 16, 2017: Irish Journal of Medical Science
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