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Perioperative Research

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113 papers 25 to 100 followers
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
K L Protopapa, J C Simpson, N C E Smith, S R Moonesinghe
BACKGROUND: Existing risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study. METHODS: The data set was split into derivation and validation cohorts...
December 2014: British Journal of Surgery
Mark A Shulman, Paul S Myles, Matthew T V Chan, David R McIlroy, Sophie Wallace, Jennie Ponsford
BACKGROUND: Survival and freedom from disability are arguably the most important patient-centered outcomes after surgery, but it is unclear how postoperative disability should be measured. The authors thus evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical population. METHODS: The authors examined the psychometric properties of World Health Organization Disability Assessment Schedule 2.0 in a diverse cohort of 510 surgical patients...
March 2015: Anesthesiology
B F Gornall, P S Myles, C L Smith, J A Burke, K Leslie, M J Pereira, J E Bost, K B Kluivers, U G Nilsson, Y Tanaka, A Forbes
BACKGROUND: Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain...
August 2013: British Journal of Anaesthesia
P S Myles, J O Hunt, H Fletcher, R Solly, D Woodward, S Kelly
BACKGROUND: Improved quality of life (QoL) is a desirable outcome of cardiac surgery. The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later. METHODS: After obtaining ethics committee approval and consent, 120 adult cardiac surgical patients were studied. A 40-item quality of recovery score (QoR-40) was used to measure postoperative health status on days 1-3 and 1 month after surgery...
October 2001: Anesthesiology
Paul A Stewart, Sophie S Liang, Qiushuang Susan Li, Min Li Huang, Ayse B Bilgin, Dukyeon Kim, Stephanie Phillips
BACKGROUND: Residual neuromuscular blockade (RNMB) has been linked to adverse respiratory events (AREs) in the postanesthetic care unit (PACU). However, these events are often not attributed to RNMB by anesthesiologists because they may also be precipitated by other factors including obstructive sleep apnea, opioids, or hypnotic agents. Many anesthesiologists believe RNMB occurs infrequently and is rarely associated with adverse outcomes. This study evaluated the prevalence and predictors of RNMB and AREs...
October 2016: Anesthesia and Analgesia
Shobana Rajan, Matthew T Hutcherson, Daniel I Sessler, Andrea Kurz, Dongsheng Yang, Michael Ghobrial, Jinbo Liu, Rafi Avitsian
BACKGROUND: Anesthesia for craniotomies should blunt responses to noxious stimuli, whereas subsequently leaving patients sufficiently alert for early neurological evaluation. The aim was to compare postoperative blood pressure control, pain, and opioid requirement after anesthesia with dexmedetomidine versus remifentanil. We therefore tested 2 primary hypotheses: (1) intraoperative administration of dexmedetomidine provides better control of postoperative blood pressure than remifentanil; and (2) patients given dexmedetomidine have less postoperative pain and use less opioid...
October 2016: Journal of Neurosurgical Anesthesiology
Mark P Johnson, Kelly A Bennett, Larry Rand, Pamela K Burrows, Elizabeth A Thom, Lori J Howell, Jody A Farrell, Mary E Dabrowiak, John W Brock, Diana L Farmer, N Scott Adzick
BACKGROUND: The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the data and safety monitoring committee and outcome data for 158 of the 183 randomized women published. OBJECTIVE: In this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair...
August 2, 2016: American Journal of Obstetrics and Gynecology
M Gram, J Erlenwein, F Petzke, D Falla, M Przemeck, M I Emons, M Reuster, S S Olesen, A M Drewes
BACKGROUND: Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted...
July 29, 2016: European Journal of Pain: EJP
Eric Jauniaux, Sally L Collins, Davor Jurkovic, Graham J Burton
OBJECTIVE: Determining the depth of villous invasiveness before delivery is pivotal in planning individual management of placenta accreta (PA). We have evaluate the value of the various ultrasound signs described in the literature for the diagnosis of PA and in the assessment of the depth of villous invasiveness. DATA SOURCES: We undertook a PubMed and MEDLINE search of the relevant studies published between the first prenatal ultrasound description of PA in 1982 and 30 March 2016 using key words "placenta accreta", "placenta increta", "placenta percreta", "abnormally invasive placenta", "morbidly adherent placenta" and "placenta adhesive disorder" as related to "sonography", "ultrasound diagnosis", "prenatal diagnosis", "grey-scale imaging", three-dimensional (3D) ultrasound and "colour Doppler imaging"...
July 26, 2016: American Journal of Obstetrics and Gynecology
L Stephen Long, William A Shapiro, Jacqueline M Leung
PURPOSE: Preoperative cognitive impairment is associated with the development of postoperative delirium, a common and consequential complication of major surgery in older patients. Screening for cognitive impairment should become a routine part of the preoperative evaluation of older patients; however, its implementation is hampered by limited clinical time and resources. The objective of this review was to identify cognitive screening tools that could be easily incorporated into the evaluation of older patients before major surgery...
August 2012: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Yun Wang, Laura P Sands, Linnea Vaurio, E Ann Mullen, Jacqueline M Leung
To determine risks for postoperative cognitive dysfunction (POCD), the authors conducted a prospective cohort study of 225 patients > or = 65 years of age undergoing noncardiac surgery. Cognitive testing using the Word List, Verbal Fluency, and Digit Symbol tests was conducted for each patient preoperatively and 1 and 2 days postoperatively in patients without postoperative delirium. POCD was defined as meeting statistical criteria for decline from the patient's preoperative performance levels on at least two of the three cognitive tests...
January 2007: American Journal of Geriatric Psychiatry
Ann P Aschenbrenner, Lisa Hanson, Teresa S Johnson, Sheryl T Kelber
OBJECTIVE: To describe the attitudes of intrapartum nurses about the importance of and intent to provide professional labor support (PLS); barriers to PLS, such as perceived subjective norms and perceived behavioral control; and relationships among attitudes, behaviors, and nurse and site characteristics. DESIGN: A cross-sectional, mixed-methods, descriptive design was guided by the Theory of Planned Behavior. SETTING: Three hospital sites in one region of a single Midwestern state...
July 2016: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Erin Sarzynski, Hamza Hashmi, Jeevarathna Subramanian, Laurie Fitzpatrick, Molly Polverento, Michael Simmons, Kevin Brooks, Charles Given
BACKGROUND: Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability...
May 6, 2016: BMJ Quality & Safety
Todd Jackson, Panpan Tian, Yang Wang, Tony Iezzi, Wenyi Xie
UNLABELLED: Presurgery emotional distress has had variable associations with outcomes of surgery in past narrative reviews. This meta-analysis was designed to evaluate the overall strengths of relations between presurgical emotional distress and key postsurgical pain outcomes (ie, pain intensity, analgesic use, functional impairment) and to identify moderators that might explain effect size heterogeneity between studies. PubMed, Web of Science, PsychINFO, Google Scholar, and Science Direct databases were searched to identify studies subjected to meta-analysis...
August 2016: Journal of Pain: Official Journal of the American Pain Society
Martin Bardsley
No abstract text is available yet for this article.
April 18, 2016: BMJ Quality & Safety
S M Yentis
No abstract text is available yet for this article.
August 2016: Anaesthesia
Deborah J Culley, Devon Flaherty, Srini Reddy, Margaret C Fahey, James Rudolph, Chuan Chin Huang, Xiaoxia Liu, Zhongcong Xie, Angela M Bader, Bradley T Hyman, Deborah Blacker, Gregory Crosby
BACKGROUND: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS: We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study...
July 2016: Anesthesia and Analgesia
Kathrin M Cresswell, Hajar Mozaffar, Lisa Lee, Robin Williams, Aziz Sheikh
BACKGROUND: Substantial sums of money are being invested worldwide in health information technology. Realising benefits and mitigating safety risks is however highly dependent on effective integration of information within systems and/or interfacing to allow information exchange across systems. As part of an English programme of research, we explored the social and technical challenges relating to integration and interfacing experienced by early adopter hospitals of standalone and hospital-wide multimodular integrated electronic prescribing (ePrescribing) systems...
April 1, 2016: BMJ Quality & Safety
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
R-R Nir, H Nahman-Averbuch, R Moont, E Sprecher, D Yarnitsky
Preoperative administration of pharmacological substances, such as non-steroidal anti-inflammatory drugs or opioids, has been gaining acclaim as a preemptive measure to minimize postoperative pain. This systematic review and meta-analysis aimed at evaluating the effectiveness of this approach in adults undergoing surgical procedures. MEDLINE, EMBASE and the Cochrane Central Register were searched from inception through January 2015. Data from randomized placebo-controlled trials were screened, extracted and assessed for risk of bias according to The Cochrane Collaboration's Tool by two independent authors...
August 2016: European Journal of Pain: EJP
2016-03-27 19:59:14
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