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[Accelerated course in hip arthroplasty]

https://arctichealth.org/en/permalink/ahliterature61715
Source
Ugeskr Laeger. 2001 Dec 3;163(49):6912-6
Publication Type
Article
Date
Dec-3-2001
Author
S. Rasmussen
M U Kramhøft
K P Sperling
J H Pedersen
I B Falck
E M Pedersen
H. Kehlet
Author Affiliation
Privathospitalet Hamlet, Frederiksberg. sten.rasmussen@dadlnet.dk
Source
Ugeskr Laeger. 2001 Dec 3;163(49):6912-6
Date
Dec-3-2001
Language
Danish
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - adverse effects - nursing - rehabilitation
Denmark
English Abstract
Female
Humans
Length of Stay
Male
Patient Discharge
Physical Therapy Modalities
Postoperative Care - methods
Preoperative Care - methods
Prospective Studies
Recovery of Function
Rehabilitation Nursing - methods
Research Support, Non-U.S. Gov't
Abstract
INTRODUCTION: The aim of the study was to assess the results of a well-defined rehabilitation programme after hip arthroplasty. METHODS: The effects of a revised, optimised, perioperative care programme with continuous epidural analgesia, oral nutrition, and physiotherapy were assessed in 60 patients before intervention and 60 patients after intervention. RESULTS: The hospital stay was reduced from nine to six days (p
PubMed ID
11766505 View in PubMed
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[Accelerated recovery program after hip fracture surgery]

https://arctichealth.org/en/permalink/ahliterature61643
Source
Ugeskr Laeger. 2002 Dec 30;165(1):29-33
Publication Type
Article
Date
Dec-30-2002
Author
Sten Rasmussen
Billy B Kristensen
Susanne Foldager
Lis Myhrmann
Henrik Kehlet
Author Affiliation
Ortopaedkirurgisk afdeling, Vejle Sygehus, DK-7300 Vejle. sten.rasmussen@dadlnet.dk
Source
Ugeskr Laeger. 2002 Dec 30;165(1):29-33
Date
Dec-30-2002
Language
Danish
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - methods - rehabilitation
Comparative Study
Denmark
Early Ambulation - methods
English Abstract
Female
Hip Fractures - rehabilitation - surgery
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Postoperative Care - methods
Preoperative Care - methods
Prospective Studies
Recovery of Function
Research Support, Non-U.S. Gov't
Retrospective Studies
Abstract
INTRODUCTION: A multimodal approach to minimise the effect of the surgical stress response can reduce complications and hospital stay after abdominal surgery and hip arthroplasty. The aim of the study was to assess the results of a well-defined rehabilitation programme after hip fracture. MATERIAL AND METHODS: In an open intervention study, we entered 200 consecutive patients with hip fracture allowing full weight-bearing after operative treatment. The effect of a revised, optimised perioperative care programme with continuous epidural analgesia, early oral nutrition, oxygen supplementation, restricted volume and transfusion therapy, and intensive physiotherapy and mobilisation was assessed (n = 100) and compared with the conventional perioperative treatment programme before the intervention (n = 100). The median age was 82 (56-96) years in the control group and 82 (63-101) years in the accelerated multimodal perioperative treatment group. RESULTS: The median hospital stay was reduced from 21 (range 1-162, mean 32) to 11 (range 1-100, mean 17) days. The total use of days in hospital was reduced from 3211 to 1667. There were fewer complications, whereas the need for home care after discharge was unchanged. CONCLUSION: An accelerated clinical pathway with focus on pain relief, oral nutrition, and rehabilitation may reduce hospital stay and improve recovery after hip fracture.
PubMed ID
12529945 View in PubMed
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The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: background, design and rationale.

https://arctichealth.org/en/permalink/ahliterature140191
Source
BMC Health Serv Res. 2010;10:284
Publication Type
Article
Date
2010
Author
Raj S Padwal
Sumit R Majumdar
Scott Klarenbach
Dan W Birch
Shahzeer Karmali
Linda McCargar
Konrad Fassbender
Arya M Sharma
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. rpadwal@ualberta.ca
Source
BMC Health Serv Res. 2010;10:284
Date
2010
Language
English
Publication Type
Article
Keywords
Adaptation, Physiological
Adaptation, Psychological
Adult
Alberta
Bariatric Surgery - economics - methods - psychology
Body mass index
Cohort Studies
Cost of Illness
Cost-Benefit Analysis
Female
Follow-Up Studies
Health Care Costs
Humans
Male
Middle Aged
Obesity, Morbid - diagnosis - surgery
Patient Satisfaction - statistics & numerical data
Patient Selection
Postoperative Care - methods
Postoperative Complications - physiopathology
Preoperative Care - methods
Prospective Studies
Quality of Life
Risk assessment
Time Factors
Treatment Outcome
Waiting Lists
Weight Loss
Abstract
Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective) economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery.
Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada), with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference-based quality of life assessment, patient satisfaction, patient utilities, anthropometric indices, cardiovascular risk factors, health care utilization and direct and indirect costs.
The results will identify the spectrum of potential risks associated with protracted wait times for bariatric care and will quantify the economic, humanistic and clinical impact of surgery from the Canadian perspective. Such information is urgently needed by health-service providers and policy makers to better allocate use of finite resources. Furthermore, our findings should be widely-applicable to other publically-funded jurisdictions providing similar care to the extremely obese.
Clinicaltrials.gov NCT00850356.
Notes
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PubMed ID
20932316 View in PubMed
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An audit of performance, interpretation, and influence of pretherapeutic MRI in rectal cancer: a Swedish population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature302524
Source
Acta Radiol. 2019 Aug; 60(8):955-961
Publication Type
Journal Article
Date
Aug-2019

[Anesthesia in severe combined gunshot and mine blast injuries].

https://arctichealth.org/en/permalink/ahliterature221599
Source
Vestn Khir Im I I Grek. 1993 Mar-Apr;150(3-4):65-8
Publication Type
Article
Author
Iu N Shanin
V Iu Shanin
Source
Vestn Khir Im I I Grek. 1993 Mar-Apr;150(3-4):65-8
Language
Russian
Publication Type
Article
Keywords
Adult
Anesthesia, General - methods
Blast Injuries - mortality - surgery
Emergencies
Humans
Intensive Care - methods
Male
Military Personnel - statistics & numerical data
Multiple Trauma - mortality - surgery
Preoperative Care - methods
Russia - epidemiology
Wounds, Gunshot - mortality - surgery
Abstract
An experience with 350 anesthesias in severely wounded patients is analyzed. Two main tasks had to be solved for successful treatment. The first one is the creation of compensation by the infusion-transfusion therapy. The second one is the defense of compensatory processes from the inhibition by pathological afferentation. The second task was being solved by combination of conductive anesthesia and rationalization of analgesia with phentanyl. This approach resulted in 13% less lethality of the patients.
PubMed ID
8379085 View in PubMed
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Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

https://arctichealth.org/en/permalink/ahliterature123614
Source
Implement Sci. 2012;7:52
Publication Type
Article
Date
2012
Author
Andrea M Patey
Rafat Islam
Jill J Francis
Gregory L Bryson
Jeremy M Grimshaw
Author Affiliation
Centre for Practice-Changing Research, Ottawa Hospital Research Institute - General Campus, Smyth Road, Ottawa, ON, Canada. apatey@ohri.ca
Source
Implement Sci. 2012;7:52
Date
2012
Language
English
Publication Type
Article
Keywords
Anesthesiology
Clinical Competence
Decision Making
Environment
Female
Health Knowledge, Attitudes, Practice
Humans
Interprofessional Relations
Interviews as Topic
Male
Medicine
Motivation
Ontario
Perception
Physicians - psychology
Preoperative Care - methods
Professional Role
Risk factors
Abstract
Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery.
Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation.
Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients' surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation).
We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.
Notes
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PubMed ID
22682612 View in PubMed
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An internist's role in perioperative medicine: a survey of surgeons' opinions.

https://arctichealth.org/en/permalink/ahliterature159268
Source
BMC Fam Pract. 2008;9:4
Publication Type
Article
Date
2008
Author
Lisa Pausjenssen
Heather A Ward
Sharon E Card
Author Affiliation
Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada. lisa.pj@usask.ca
Source
BMC Fam Pract. 2008;9:4
Date
2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cooperative Behavior
General Surgery - statistics & numerical data
Health Care Surveys
Heart Diseases - surgery
Humans
Internal Medicine - standards
Interprofessional Relations
Perioperative Care - methods - standards
Physician's Role
Physician-Patient Relations
Preoperative Care - methods - standards
Questionnaires
Referral and Consultation - standards
Saskatchewan
Surgery Department, Hospital - manpower
Abstract
Literature exists regarding the perioperative role of internists. Internists rely on this literature assuming it meets the needs of surgeons without actually knowing their perspective. We sought to understand why surgeons ask for preoperative consultations and their view on the internist's role in perioperative medicine.
Survey of surgeons in Saskatoon, Saskatchewan, Canada regarding an internist's potential role in perioperative care.
Fifty-nine percent responded. The majority request a preoperative consultation for a difficult case (83%) or specific problem (81%). While almost half feel that a preoperative consultation is to "clear" a patient for surgery, 33% disagree with this statement. The majority believe the internist should discuss risk with the patient. Aspects of the preoperative consultation deemed most important are cardiac medication optimization (93%), cardiac risk stratification (83%), addition of beta-blockers (76%), and diabetes management (74%).
Surgeons perceive the most important roles for the internist as cardiac risk stratification and medication management. Areas of controversy identified amongst the surgeons included who should inform the patient of their operative risk, and whether the internist should follow the patient daily postoperatively. Unclear expectations have the potential to impact on patient safety and informed consent unless acknowledged and acted on by all. We recommend that internists performing perioperative consults communicate directly with the consulting physician to ensure that all parties are in accordance as to each others duties. We also recommend that the teaching of perioperative consults emphasizes the interdisciplinary communication needed to ensure that patient needs are not neglected when one specialty assumes the other will perform a function.
Notes
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PubMed ID
18208614 View in PubMed
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Antithrombotic- and anticoagulation regimens in OPCAB surgery. A Nordic survey.

https://arctichealth.org/en/permalink/ahliterature171529
Source
Scand Cardiovasc J. 2005 Dec;39(6):369-74
Publication Type
Article
Date
Dec-2005
Author
Katrine H Hansen
Pia Hughes
Daniel A Steinbrüchel
Author Affiliation
Department of Cardiothoracic Surgery, H:S Rigshospitalet, Copenhagen University Hospital, Denmark. katrineha3@m1.stud.ku.dk
Source
Scand Cardiovasc J. 2005 Dec;39(6):369-74
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Anticoagulants - therapeutic use
Chemoprevention
Coronary Artery Bypass, Off-Pump - adverse effects - methods - utilization
Drug Utilization Review
Fibrinolytic Agents - therapeutic use
Finland
Health Care Surveys
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Iceland
Physician's Practice Patterns
Platelet Aggregation Inhibitors - therapeutic use
Postoperative Care - methods
Preoperative Care - methods
Questionnaires
Scandinavia
Abstract
The aim of the survey was to determine current practices for antiplatelet- and heparin therapy in OPCAB surgery in the Nordic countries.
A postal survey questionnaire was sent to all 26 departments of Cardiothoracic Surgery in Norway, Sweden, Iceland, Finland, and Denmark.
The overall response rate was 100%. The respondents performed between 130 and 1000 CABG procedures per year. Between 0.3% and 42.0% of these procedures were performed as OPCAB. Preoperative antiplatelet therapy was administered by 48%, while 96% routinely administer postoperative antiplatelet therapy. In the postoperative antiplatelet therapy there was a trend toward a combination of aspirin and low molecular weight heparin. Perioperative anticoagulation practices with heparin varied among departments as well as reversal with protamine. Eighty percent of the respondents register postoperative complications.
In the Nordic countries there is no uniform practice regarding antiplatelet therapy pre- and postoperatively as well as heparin therapy perioperatively. Dose regimens are highly variable and standard protocols have not yet been developed.
PubMed ID
16352490 View in PubMed
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Bilateral same day phacoemulsification: 220 cases retrospectively reviewed.

https://arctichealth.org/en/permalink/ahliterature50712
Source
Br J Ophthalmol. 2003 Mar;87(3):285-90
Publication Type
Article
Date
Mar-2003
Author
B A Johansson
B L Lundh
Author Affiliation
Department of Ophthalmology, University Hospital of Linköping, Sweden. bjorn.johansson@lio.se
Source
Br J Ophthalmol. 2003 Mar;87(3):285-90
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Ambulatory Surgical Procedures - methods
Anisometropia - surgery
Cataract - physiopathology
Female
Humans
Male
Middle Aged
Phacoemulsification - methods
Preoperative Care - methods
Retrospective Studies
Visual Acuity - physiology
Abstract
BACKGROUND/AIMS: The relative frequency, basic patient data, results, and complications of planned same day bilateral phacoemulsification were studied from April 1999 to May 2001 at the Department of Ophthalmology, Linköping University Hospital, Sweden. METHODS: Retrospective study of patient records (n=220) regarding preoperative and postoperative visual acuity, applied indications, concurrent disease, preoperative, peroperative, and postoperative complications, and number of unplanned postoperative visits. The monthly rate of bilateral phacoemulsification to all cataract procedures was monitored. RESULTS: Mean corrected preoperative visual acuity was 0.27 (worse eye) and 0.39 (better eye), and postoperatively (all eyes) 0.71. Visual acuity was 0.5 or better in 78% of eyes. Preoperative considerations included type of cataract, to avoid anisometropia, social circumstances, and concurrent eye disease. Reasons for unplanned postoperative visits included secondary cataract (n=10), iritis (n=6), corneal oedema (n=3), cortex in the anterior chamber (n=2), and unilateral endophthalmitis (n=2). During the study period, 10.5% of patients were operated upon bilaterally on the same day. CONCLUSIONS: Same day bilateral phacoemulsification was found to be a safe and cost effective way of rapidly rehabilitating selected cataract patients. The patient must be informed of the added potential risks as well as the benefits of the procedure.
PubMed ID
12598439 View in PubMed
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162 records – page 1 of 17.