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https://www.readbyqxmd.com/read/29340526/simulating-the-behavior-of-patients-who-leave-a-public-hospital-emergency-department-without-being-seen-by-a-physician-a-cellular-automaton-and-agent-based-framework
#1
Milad Yousefi, Moslem Yousefi, F S Fogliatto, R P M Ferreira, J H Kim
The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression...
January 11, 2018: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/29337046/the-impact-of-fast-track-protocols-in-upper-gastrointestinal-surgery-a-meta-analysis-of-observational-studies
#2
REVIEW
Charalampos Siotos, Konstantinos Stergios, Androniki Naska, Maximos Frountzas, Vasilios Pergialiotis, Despina N Perrea, Nikolaos Nikiteas
BACKGROUND: Fast track surgery has been implemented in colorectal procedures during the last decade and is accompanied by significant improvement in patient outcomes during the early postoperative period. However, to date, its adoption in upper gastrointestinal surgery remains a matter of debate. In this context, we aimed to summarize the existing evidence in the international literature. MATERIALS AND METHODS: We searched Medline, Scopus, ClinicalTrials.gov and Cochrane Central Register databases for published randomized controlled trials...
January 12, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/29327248/introducing-new-technology-safely-into-urological-practice
#3
Siska Van Bruwaene, Benjamin Namdarian, Ben Challacombe, Ben Eddy, Ignace Billiet
PURPOSE: Surgical innovation is necessary to ensure continued improvement in patient care. However, several challenges unique to the surgical craft are encountered during the development and validation of such new technology. This article highlights some of these challenges and gives an overview of existing solutions. METHODS: A Pubmed review was performed about the "introduction of new technology" to identify challenges. Cross-referencing was used to explore the possible solutions per challenge...
January 11, 2018: World Journal of Urology
https://www.readbyqxmd.com/read/29306574/incidence-and-risk-factors-of-postoperative-urinary-retention-and-bladder-catheterization-in-patients-undergoing-fast-track-total-joint-arthroplasty-a-prospective-observational-study-on-371-patients
#4
Ruben Scholten, Keetie Kremers, Sebastiaan A W van de Groes, Diederik M Somford, Sander Koëter
BACKGROUND: Postoperative urinary retention (POUR) appears to be a common complication in lower limb joint arthroplasty; however, reports on its incidence vary. There is no general consensus on its definition and there is no scientific evidence on treatment principles. We performed a prospective observational study to establish the incidence of POUR and its risk factors, including the preoperative postvoid residual urine volume and the perioperative fluid balance, in fast-track total joint arthroplasty (TJA)...
December 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29302723/second-generation-of-a-fast-track-liver-resection-programme
#5
Nicolai A Schultz, Peter N Larsen, B Klarskov, L M Plum, Hans-Jørgen Frederiksen, Henrik Kehlet, Jens G Hillingsø
BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection. METHODS: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection...
January 4, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29290033/effects-of-obesity-and-metabolic-syndrome-on-cardiovascular-outcomes-in-pediatric-kidney-transplant-recipients-a-longitudinal-study
#6
Kristen Sgambat, Sarah Clauss, K Y Lei, Juizhou Song, Shaik O Rahaman, Margaret Lasota, Asha Moudgil
BACKGROUND: Obesity and metabolic syndrome (MS) are common after kidney transplantation, but their contribution to adverse cardiovascular (CV) outcomes in children are not well known. A prospective, controlled, longitudinal cohort study was conducted to investigate the effects of obesity and MS on left ventricular hypertrophy (LVH) and myocardial strain in pediatric kidney transplant recipients. METHODS: Transplant recipients (n = 42) had anthropometrics [body mass index (BMI), waist circumference, waist-to-height ratio], biochemical parameters (fasting glucose, lipid panel, HbA1c%), and echocardiogram with speckle tracking analysis for strain measured at 1, 18, and 30 months post-transplant...
December 30, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29288114/efficacy-of-fast-track-surgery-in-laparoscopic-radical-gastrectomy-for-gastric-cancer-a-meta-analysis-of-randomized-controlled-trials
#7
REVIEW
Qing Liu, Li Ding, Honglei Jiang, Chundong Zhang, Junzhe Jin
OBJECTIVE: To conduct a systematic review of efficacy and security of fast track surgery (FTS) in laparoscopic radical gastrectomy for gastric cancer. METHODS: We searched PubMed, Embase, and Cochrane Library Databases and supplemented by other searches to collect randomized controlled trials (RCTs) on the comparison of fast track surgery combined with laparoscopy versus laparoscopy separately used in radical gastrectomy for gastric cancer before December 2016. After screening for inclusion, data extraction, and quality assessment, meta-analysis was conducted by the Review Manager 5...
December 26, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29284832/application-of-discharge-criteria-for-home-readiness-using-bispectral-and-supraglottic-airway-devices-in-day-care-surgery-without-using-muscle-relaxants
#8
Joginder Pal Attri, Manjit Singh, Hemchandra Bhatt, Kamal Jyoti, Harjinder Kaur
Introduction: The availability of rapid and short-acting intravenous and volatile anesthetics has facilitated early recovery that is why nowadays ambulatory surgery is becoming more common. If the criteria used to discharge patients from the Postanesthesia Care Unit (PACU) are met in the operating room (OR), it would be appropriate to consider bypassing the PACU and transferring the patient directly to the step-down unit. This process is known as "fast-tracking" after ambulatory surgery...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29273285/the-danish-head-and-neck-cancer-fast-track-program-a%C3%A2-tertiary-cancer-centre-experience
#9
Anders B Roennegaard, Tine Rosenberg, Kristine Bjørndal, Jens Ahm Sørensen, Jørgen Johansen, Christian Godballe
INTRODUCTION: During the 1990s, all Nordic countries except for Denmark experienced a general increase in 5-year survival rates for cancer patients. In 2007, the Danish National Board of Health in collaboration with national multidisciplinary cancer groups and the Danish regions initiated fast-track clinical pathway solutions. OBJECTIVES: The objectives of this study were 1) to present the setup of the head and neck cancer (HNC) fast-track program at Odense University Hospital (OUH) as an example of the Danish model and 2) to present patient characteristics, diagnostic outcome, cancer detection rate, and duration of the fast-track patient courses...
December 19, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/29262403/sacubitril-valsartan-in-an-elderly-patient-with-heart-failure-a-case-report
#10
Matteo Cameli, Maria Concetta Pastore, Antonio Pagliaro, Cristina Di Tommaso, Rosanna Reccia, Valeria Curci, Giulia Elena Mandoli, Sergio Mondillo
Sacubitril/valsartan has recently been approved for the treatment of heart failure with reduced ejection fraction. Given its recent introduction in the armamentarium for the treatment of heart failure (HF), "field-practice" evidence is required to deepen the clinical management of sacubitril/valsartan therapy. We report a relevant case of an elderly patient who achieved major clinical benefits after only 3 months of sacubitril/valsartan therapy. Importantly, in our assessment, we employed speckle tracking echocardiography (STE), a recent echocardiography technique that is non-Doppler and not angle dependent, which analyzes deformations of heart chambers from standard images and allows a fast, reliable, and reproducible assessment of heart function...
2017: Cardiology
https://www.readbyqxmd.com/read/29260691/-fast-track-hip-arthroplasty
#11
Torben Bæk Hansen, Kirill Gromov, Billy B Kristensen, Henrik Husted, Henrik Kehlet
Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden...
December 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29251207/perioperative-outcomes-from-the-prospective-multicenter-least-invasive-fast-track-evar-life-registry
#12
Zvonimir Krajcer, Venkatesh G Ramaiah, Esteban A Henao, D Chris Metzger, Wayne K Nelson, Mohammed M Moursi, Hiranya A Rajasinghe, Raed Al-Dallow, Larry E Miller
PURPOSE: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. METHODS: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge...
December 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/29239152/the-safety-and-efficiency-of-a-fast-track-protocol-for-sleeve-gastrectomy-a-team-approach
#13
Sebastiaan J Vreeswijk, Pim W van Rutte, Simon W Nienhuijs, R Arthur Bouwman, J Frans Smulders, Marc P Buise
BACKGROUND: Increasing numbers of morbid obese patients has led to increased numbers of bariatric procedures. Fast-track protocols are being developed to enhance the available resources, while maintaining a safe procedure. Reported results on safety merely apply to a mixed bariatric population. The objective was to evaluate safety and efficiency of the fast-track principles in patients undergoing sleeve gastrectomy. METHODS: Retrospective observational study including patients undergoing primary sleeve gastrectomy at the Obesity Centre of the Catharina Hospital Eindhoven, the Netherlands...
December 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29219242/behavioural-assessment-unit-improves-outcomes-for-patients-with-complex-psychosocial-needs
#14
George Braitberg, Marie Gerdtz, Susan Harding, Steven Pincus, Michelle Thompson, Jonathan Knott
OBJECTIVE: We aimed to assess the impact of a new model of care for patients presenting to the ED with acute behavioural disturbance. METHODS: This pre-/post-intervention study involved creating a dedicated, highly resourced six bed unit, the behavioural assessment unit (BAU). Co-located with the ED at the Royal Melbourne Hospital, the unit was designed to fast-track the admission of patients affected by intoxication, mental illness or psychosocial crisis and provide front-loaded interventions...
December 8, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29212781/analysis-of-drug-development-paradigms-for-immune-checkpoint-inhibitors
#15
Denis L Jardim, Debora de Melo Gagliato, Francis J Giles, Razelle Kurzrock
Immune checkpoint inhibitors have unique toxicities and response kinetics compared to cytotoxics and gene-targeted anti-cancer agents. We investigated the impact of innovative/accelerated immunotherapy drug development/approval models on the accuracy of safety and efficacy assessments by searching the US Food and Drug Administration (FDA) website. Initial phase I trials for each agent were reviewed and safety and efficacy data compared to that found in later trials leading to regulatory approvals of the same agents...
December 6, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29209980/predictors-of-increased-length-of-hospital-stay-following-laparoscopic-sleeve-gastrectomy-from-the-national-surgical-quality-improvement-program
#16
Reid Fletcher, Rebecca Deal, John Kubasiak, Alfonso Torquati, Philip Omotosho
BACKGROUND: Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure in the USA. Identifying preoperative risk factors for prolonged postoperative hospital stay will help appropriately select patients for fast-track protocols and avoid costly readmissions. To date, there has been no large national database analysis of risk factors for prolonged length of stay following laparoscopic sleeve gastrectomy. METHODS: Laparoscopic sleeve gastrectomy procedures reported to the American College of Surgeons National Surgical Quality Improvement Program between 2009 and 2012 were reviewed...
December 5, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29209162/characterization-of-cochlear-vestibular-and-cochlear-vestibular-electrically-evoked-compound-action-potentials-in-patients-with-a-vestibulo-cochlear-implant
#17
T A K Nguyen, Samuel Cavuscens, Maurizio Ranieri, Konrad Schwarz, Nils Guinand, Raymond van de Berg, Thomas van den Boogert, Floor Lucieer, Marc van Hoof, Jean-Philippe Guyot, Herman Kingma, Silvestro Micera, Angelica Perez Fornos
The peripheral vestibular system is critical for the execution of activities of daily life as it provides movement and orientation information to motor and sensory systems. Patients with bilateral vestibular hypofunction experience a significant decrease in quality of life and have currently no viable treatment option. Vestibular implants could eventually restore vestibular function. Most vestibular implant prototypes to date are modified cochlear implants to fast-track development. These use various objective measurements, such as the electrically evoked compound action potential (eCAP), to supplement behavioral information...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29208509/the-use-of-an-intraarticular-catheter-on-fast-track-primary-knee-arthroplasty-is-it-a-step-forward
#18
L Cáceres-Sánchez, J B García-Benítez, V Coronado-Hijón, M Montero-Pariente
OBJECTIVE: This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. MATERIAL AND METHOD: Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen)...
December 2, 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/29204497/decreased-risk-of-knee-buckling-with-adductor-canal-block-versus-femoral-nerve-block-in-total-knee-arthroplasty-a-retrospective-cohort-study
#19
Ryan R Thacher, Thomas R Hickernell, Matthew J Grosso, Roshan Shah, Herbert J Cooper, Robert Maniker, Anthony Robin Brown, Jeffrey Geller
Background: Femoral nerve (FNB) and adductor canal blocks (ACB) are used in the setting of total knee arthroplasty (TKA), but neither has been demonstrated to be clearly superior. Although dynamometer studies have shown ACBs spare perioperative quadriceps function when compared to FNBs, ACBs have been widely adopted in orthopaedic surgery without significant evidence that they decrease the risk of perioperative falls. Methods: All patients who received single-shot FNB (129 patients) or ACB (150 patients) at our institution for unilateral primary TKA from April 2014 to September 2015 were retrospectively reviewed for perioperative falls or near-falls during physical therapy and inpatient care...
December 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/29202644/outpatient-total-hip-and-knee-arthroplasty
#20
Stephan B W Vehmeijer, Henrik Husted, Henrik Kehlet
As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpatient procedures in selected patients. However, in literature the term "outpatient" is sometimes also used for patients who spend one or more nights in hospital. We therefore propose to use "outpatient" solely for patients who are discharged to their own home on the day of surgery and do not have an overnight stay at either the hospital or another non-home facility...
December 5, 2017: Acta Orthopaedica
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