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fast tracking patients

Joshua L Chan, Justin G Miller, Mandy Murphy, Ann Greenberg, Peggy Iraola, Keith A Horvath
BACKGROUND: Prolonged intubation following cardiac surgery is associated with significant morbidity. A fast-track extubation protocol primarily driven by bedside providers was instituted for all postoperative cardiac surgery patients to facilitate safe and expeditious extubation. METHODS: A retrospective review of 1581 cardiac surgery patients over an 8-year period was performed. Prior to 2011, non-protocolized standard perioperative management was utilized (n=807)...
March 9, 2018: Annals of Thoracic Surgery
Clothilde Philouze, Philippe Obert, Stéphane Nottin, Asma Benamor, Olivier Barthez, Falah Aboukhoudir
BACKGROUND: Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest...
March 8, 2018: Journal of the American Society of Echocardiography
E García, M P Blanco, S Riaño, I González-Mendibil, T Carrascosa, M T Antolín
A description is presented on the management of a patient with an oesophageal neoplasm scheduled for oesophagectomy. Alloantibodies were detected during a blood components reservation procedure, which made it almost impossible to obtain compatible blood. Peri-operative anaemia management or "Patient Blood Management" should be routinely performed in all patients at transfusion risk. This strategy has been considered as one of the actions to bear in mind in fast-track surgery or enhanced recovery after surgery...
March 7, 2018: Revista Española de Anestesiología y Reanimación
Jaime Ruiz-Tovar, José Luis Muñoz, Pablo Royo, Manuel Duran, Elisabeth Redondo, Jose Manuel Ramirez
INTRODUCTION: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care...
March 8, 2018: Minimally Invasive Therapy & Allied Technologies: MITAT
Emanuele Asti, Gianluca Bonitta, Matteo Melloni, Stefania Tornese, Pamela Milito, Andrea Sironi, Elena Costa, Luigi Bonavina
BACKGROUND: Early detection of anastomotic leakage after esophagectomy has the potential to reduce morbidity and mortality. Prompt suspicion of leak may help to exclude patients from fast-track protocols, thereby avoiding early oral feeding and early hospital discharge which could aggravate the prognosis of a clinically occult leak. PATIENTS AND METHODS: Observational retrospective cohort study. Patients with diagnosis of esophageal cancer who underwent elective minimally invasive esophagectomy were included...
March 7, 2018: Langenbeck's Archives of Surgery
Fiammetta Monacelli, Alessio Signori, Matteo Prefumo, Chiara Giannotti, Alessio Nencioni, Emanuele Romairone, Stefano Scabini, Patrizio Odetti
Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer...
January 2018: Dementia and Geriatric Cognitive Disorders Extra
Qingqing Wang, Kaibin Tan, Hongmei Xia, Yunhua Gao
AIMS: The aims of the current study were to analyze and compare the left ventricular (LV) structure and function in type 2 diabetes mellitus (T2DM) patients with or without hyperlipidemia using conventional echocardiography and real-time three-dimensional speckle tracking echocardiography (3DSTE) and to determine the variables that could affect LV strain values in these patients. METHODS: Eighty-one T2DM patients with normal LVEF (≥55%) were included, 41 of whom had hyperlipidemia as comorbidity...
March 6, 2018: Echocardiography
Tafireyi Marukutira, Mark Stoové, Shahin Lockman, Lisa A Mills, Tendani Gaolathe, Refeletswe Lebelonyane, Joseph N Jarvis, Sherrie L Kelly, David P Wilson, Stanley Luchters, Suzanne M Crowe, Margaret Hellard
UNAIDS 90-90-90 targets and Fast-Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS-related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle-income country with the third-highest HIV prevalence, and Australia, a low-prevalence high-income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90-90-90 targets...
March 2018: Journal of the International AIDS Society
Margaret Smith, Glenn Wakam, Thomas Wakefield, Andrea Obi
Anticoagulation pharmacy has been dramatically altered with US Food and Drug Administration (FDA) approval of 5 direct oral anticoagulants, 1 novel reversal agent and, a second designated for fast-track approval. Trial data surrounding current trends in anticoagulant choice for VTE, reversal, and bridging are constantly redefining practice. Extended therapy for unprovoked VTE has expanded to include low-dose direct oral anticoagulants, aspirin, and the use of the HERDOO2 system to identify women who can stop anticoagulant therapy without increased risk of recurrent VTE...
April 2018: Surgical Clinics of North America
Pooja Bhangui, Prashant Bhangui, Nikunj Gupta, Annu Sarin Jolly, Seema Bhalotra, Nishant Sharma, A S Soin, Vijay Vohra
Background and Aims: Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT. Methods: We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses...
February 2018: Indian Journal of Anaesthesia
Gianni Biancofiore, Dana Rodica Tomescu, M Susan Mandell
A body of scientific studies has shown that early extubation is safe and cost-effective in a large number of liver transplant (LT) recipients including pediatric patients. However, fast-track practices are not universally accepted, and debate still lingers about whether these interventions are safe and serve the patients' best interest. In this article, we focus on reasons why physicians still have a persistent, although diminishing, reluctance to adopt fast-track protocols. We stress the importance of collection/analysis of perioperative data, adoption of a consensus-based standardized protocol for perioperative care, and formation of LT anesthesia focused teams and leadership...
February 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Ola S Ahmed, Ailín C Rogers, Jarlath C Bolger, Achille Mastrosimone, William B Robb
BACKGROUND: Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery. METHODS: The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria...
February 27, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Maximilian B Bibok, Kristine Votova, Robert F Balshaw, Mary L Lesperance, Nicole S Croteau, Anurag Trivedi, Jaclyn Morrison, Colin Sedgwick, Andrew M Penn
BACKGROUND: To evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients. Differentiating between true and false TIA/minor stroke cases (mimics) is necessary for effective triage as medical intervention for true TIA/minor stroke is time-sensitive and TIA unit spots are a finite resource. METHODS: Prospective cohort study design utilizing patient referral data and TIA unit arrival times from a regional fast-track TIA unit on Vancouver Island, Canada, accepting referrals from emergency departments (ED) and general practice (GP)...
February 27, 2018: BMC Health Services Research
Stephen J Traub, Soroush Saghafian, Kurtis Judson, Christopher Russi, Bo Madsen, Stephen Cha, Hannah C Tolson, Leon D Sanchez, Jesse M Pines
BACKGROUND: Emergency physicians differ in many ways with respect to practice. One area in which interphysician practice differences are not well characterized is emergency department (ED) length of stay (LOS). OBJECTIVE: To describe how ED LOS differs among physicians. METHODS: We performed a 3-year, five-ED retrospective study of non-fast-track visits evaluated primarily by physicians. We report each provider's observed LOS, as well as each provider's ratio of observed LOS/expected LOS (LOSO/E ); we determined expected LOS based on site average adjusted for the patient characteristics of age, gender, acuity, and disposition status, as well as the time characteristics of shift, day of week, season, and calendar year...
February 14, 2018: Journal of Emergency Medicine
Antonio D'Andrilli, Erino A Rendina
Main specific interventions for preoperative clinical optimisation of patients undergoing lung cancer surgery include assessment and treatment of comorbidities, minimizing preoperative hospitalization, minimizing preoperative fasting, and optimisation of antibiotic and thrombo-embolic prophylaxis. Preoperative patient optimisation is considered a crucial part of enhanced recovery after thoracic surgery pathways. Potentially, advantages of this fast-track management could be even higher when considering video-assisted thoracic surgery (VATS) major lung resection, because reduced trauma related to minimally invasive techniques is one of the main factors improving postoperative outcome...
2018: Journal of Visualized Surgery
James Howells, Hugh Bostock, Susanna B Park, Matthew C Kiernan, David Burke
BACKGROUND: Excitability studies on normal and diseased human axons in vivo have been greatly enhanced by fast non-invasive threshold-tracking techniques, using surface stimulation and recording. Although sensory axons are often more affected in disease, most studies to date have focussed on motor axons, because of technical difficulties in resolving pathologically small nerve volleys in the presence of noise and stimulus artefact. NEW METHODS: This paper describes techniques for tracking low-amplitude compound action potentials, using a battery-powered, isolated preamplifier of simple construction with high common mode rejection (>125 dB [balanced inputs]) and low noise (<0...
February 11, 2018: Journal of Neuroscience Methods
Toby Helliwell, Sara Muller, Samantha L Hider, James A Prior, Jane C Richardson, Christian D Mallen
BACKGROUND: In the UK, general practitioners (GPs) are usually the first medical contact for patients with suspected giant cell arteritis (GCA). While rare, it is critical not to miss, as delayed treatment can lead to significant complications including permanent visual loss. To date, little is known about the approach and challenges to diagnosis and management of GCA by GPs. OBJECTIVE: To investigate the diagnosis and management of patients with suspected GCA in UK general practice...
February 3, 2018: BMJ Open
Hiranya A Rajasinghe, Larry E Miller, Zvonimir Krajcer
PURPOSE: To determine feasibility, safety, and effectiveness of a fast-track endovascular aneurysm repair (EVAR) protocol at teaching and nonteaching hospitals. METHODS: Patients underwent a fast-track EVAR protocol comprised of bilateral percutaneous access using a 14 Fr stent graft, avoidance of general anesthesia and intensive care admission, and next-day discharge. Patients were followed through 1 month post-treatment. Participating hospitals were categorized by teaching status (teaching vs...
February 6, 2018: Annals of Vascular Surgery
Anuj Jain, Varadarajan Muralidhar, Sanjeev Aneja, Anil Kumar Sharma
Background and Aims: Mostly, institutions in India have single post-anaesthesia care unit (PACU) which follows traditional time-based discharge (TBD) method. Recently, it has been classified into PACU Phase I and Phase II, and criteria-based discharge (CBD) method has been used. This study primarily compares CBD versus TBD methods in moving patients through PACU, and other non-clinical factors causing delay in shifting. Methods: One hundred patients, aged 18-65 years, American Society of Anesthesiologist's physical status I and II, scheduled for elective minor surgeries under general anaesthesia were studied...
January 2018: Indian Journal of Anaesthesia
W H van Harten, N Goedbloed, A H Boekhout, S Heintzbergen
BACKGROUND: In general, patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. Using various "operations management" techniques a few fast track diagnostic services were implemented in the Netherlands Cancer Institute (NKI) in 2006. Growing patient numbers and increasing process complexity, led to diminished service levels. To decrease the amount of patient visits and to extend these services beyond the (obvious) breast cancer services, fast track diagnostics is now implemented for all 18 cancer types that present with a frequency of minimally one per week...
February 7, 2018: BMC Health Services Research
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