Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics.

The enhanced recovery after surgery (ERAS) protocol is not routine management in paediatric orthopaedics. Cultural differences or assumptions about the financing of medical care in different countries encourage creative adaptation of general assumptions in local communities. The aim of this study was to compare the quality of the perioperative period before and after the introduction of an interdisciplinary protocol adopted to organisational conditions. A group of 4098 children were included in the "before-after" observational study. The data of 1553 patients (BEFORE group) were analysed in terms of compliance with the enhanced recovery after surgery protocol guidelines and the time and cost of hospitalisation over a 20-month period. A novel interdisciplinary protocol was developed, including an education and training app called BackOnFeet (BOF®), standardised hospital management, and the introduction of methods novel to Poland (intraoperative nerve cryoanalgesia in children). A further 2545 patients (AFTER group) were reassessed over a period of 20 months. It was found that the groups differed in hospitalisation time (p < 0.001), type of procedures, and percentage ratio of costs incurred to revenue generated. The usefulness of the BOF® app as an effective educational tool was demonstrated. The optimisation of perioperative management in paediatric orthopaedics based on novel tools and the interdisciplinary ERAS protocol is possible and brings tangible benefits in psychological, organisational, and financial terms.

Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application-a new strategy to improve outcomes.

Introduction: The surgical Nuss correction of the funnel chest deformity is a painful procedure without an established consensus of pain relief methods. High doses and long duration of opioids requirements impedes the ERAS protocol introduction. The aim of this study was to evaluate the effectiveness of intraoperative intercostal nerve cryolysis in terms of pain management in relation to the routinely used multimodal analgesia in Poland. We also assessed the impact of using the proprietary "BackOnFeet" application on the quality of life of patients after surgery in relation to the ERAS protocol. Methods: The prospective, single-centre, non-randomised, before-after pilot study was conducted. Inclusion criteria were: funnel-shaped chest deformity, age range 11-18 years, first chest wall operation, agreement for the cryolysis and regional analgesia, no history of chronic painkillers use. The results of the "control group" (multimodal analgesia with regional analgesia commonly performed in Poland) were assessed. The interdisciplinary perioperative protocol with the "BackOnFeet" application and intraoperative intercostal nerve cryoanalgesia were introduced to the "intervention group". Results: Eighteen children were treated with standard protocol typical for Polish management and matched to eighteen patients who received cryoanalgesia and the "BackOnFeet" application access "intervention group". We noticed lower NRS points in first 24 h (p = 0.0048), shortening of time of opioid use (p = 0.0002), hospitalisation time (p = 0,01), improved quality of postoperative rehabilitation (p < 0.0001) and quality of life (p < 0.0001) among the "intervention group". Conclusions: Intraoperative intercostal nerves cryolysis performed during the minimally invasive Nuss correction of funnel deformation in combination with bilateral is more effective in terms of acute pain management in relation to the routinely used multimodal analgesia in Poland, allowing for the shortening of time of opioid use, hospitalisation time, improved quality of postoperative rehabilitation and enabled ERAS protocol introduction. The use of the proprietary "BackOnFeet" application has a positive effect on the quality of life of patients after surgery.

[Evaluation of quality and accessibility of health education materials. I. The opinion of health personnel]. / Ocena jakosci i dostepnosci materialów edukacyjnych o zdrowiu. I. Opinie pracowników sluzby zdrowia.

The study concerning quality and accessibility of educational materials for health workers was taken up in 2003 in Health Promotion Department of the National Institute of Hygiene and Mazovian Centre of Public Health. Two questionnaires were elaborated: a) for physicians, b) for social-and-familial nurses. The questionnaire for physicians contains demographic data and questions about health education materials (accessibility, sufficiency, themes of received materials, and expectations concerning themes and forms). The questionnaire for social-and-familial nurses consists of demographic data and questions about health education materials (sources of materials, patients' concern with materials, adequacy for patients' interest, and needs concerning themes and forms). Data were obtained from 112 nurses (110 females and 2 males) working in Warsaw hospitals (37.6%), regional dispensaries (33.0%), specific dispensaries (11.9%) and other health services (19.5%). Majority of physicians (82.7%) answered that they received health education materials, but only 32.9% assessed the number as sufficient. More then seventy percents of physicians assessed, that materials in high degree concern advertising of pharmaceutical drugs and other commercial products, while only 11.3%--health promotion and healthy lifestyle, and 5%--disease prevention. One from three physicians needed educational materials for patients to give them during visits in high degree. As regards to themes, physicians most frequently mentioned disease prevention (41.1%), health promotion and healthy lifestyle (37.7%), treatment (34.9%), diet and nutrition (20.7%). Booklets, leaflets and posters were the forms of health education materials, which physicians noticed most frequently. Regarding social-and-familial nurses, almost all (95%) received health materials from pharmaceutical and other commercial institutions, 68.5% from public institutions and 26.6% from foundations. Only one from five of the nurses assessed, that materials captured high interest of the patients, and 13.6% of the nurses stated, that received health education materials were adequate to health information needs of patients in high degree. Nearly the same percentage of nurses as physicians (41.4%) mentioned disease prevention as most desirable theme of health education materials, lower percentage mentioned treatment (29.5%) and health promotion and healthy lifestyle (19.8%). Our findings showed that most of health materials were received from pharmaceutical and other commercial institutions. Moreover, the interest to have educational materials concerning health promotion and healthy lifestyle is low, especially among social-and-familial nurses.

[Evaluation of quality and accessibility of health education materials. II. The opinion of patients]. / Ocena jakosci i dostepnosci materialow edukacyjnych o zdrowiu. II. Opinie pacjentów.

The study on quality and accessibility of educational materials for patients was taken up in Health Promotion Department of the National Institute of Hygiene and the Mazovian Centre of Public Health in 2003. The questionnaire contained demographic information (gender, age, civil state, residence, employment and level of education), and questions about patients' opinions concerning the sources of health information (usefulness for knowledge enlargement, use in everyday life and perceived truth). The data were obtained from 110 patients living in Warsaw, who waited for visit in dispensaries or had treated in hospitals. The patients pointed television (54.5% of respondents), members of family (50.9%), physician or nurse in the course of consultations (48.2%), journals (46.4%) and friends (43.6%) as the sources, which most frequently provided health information. Women significantly more frequently than men acquired health information from journals (respectively: 53.8% and 26.7%), while men more frequently than women received health information from physicians or nurses in course of visits (respectively: 66.7% and 41.3%). As regards to age, the younger patients significantly more frequently acquired health information from family (younger group--61.2%, medium group--37.9%, elder group - 28,2%), friends (respectively: 55.2%, 27.2%, 21.4%) and from educational materials exposed in specific dispensaries (respectively: 44.8%, 17.2%, 14.3%). The elder patients more frequently received health information from physicians or nurses in course of consultations (elder group--85.7%, medium group--62.1%, younger group--34.3%). In comparison with other sources, the highest percentage of respondents assessed health information received from physician or nurse as very useful for enlargement their knowledge, use in their everyday life and very true, however, this percentage is low (respectively: 29.0%, 25.7% and 46.7%). Our findings confirm the need to elaborate health education materials more adequate to patients' expectations.