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1.
BMC Musculoskelet Disord ; 25(1): 354, 2024 May 04.
Article En | MEDLINE | ID: mdl-38704573

BACKGROUND: This study aimed to investigate the impact of nursing interventions on the rehabilitation outcomes of patients after lumbar spine surgery and to provide effective references for future postoperative care for patients undergoing lumbar spine surgery. METHODS: The study included two groups: a control group receiving routine care and an observation group receiving additional comprehensive nursing care. The comprehensive care encompassed postoperative rehabilitation, pain, psychological, dietary management, and discharge planning. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Short-Form 36 (SF-36) Health Survey, self-rating depression scale (SDS) and self-rating anxiety scale(SAS) were used to assess physiological and psychological recovery. Blood albumin, haemoglobin, neutrophil counts, white blood cell counts, red blood cell counts, inflammatory markers (IL-6, IL-10, and IFN-γ) were measured, and the incidence of postoperative adverse reactions was also recorded. RESULTS: Patients in the observation group exhibited significantly improved VAS, ODI, SF-36, SDS and SAS scores assessments post-intervention compared to the control group (P < 0.05). Moreover, levels of IL-6, IL-10, and IFN-γ were more favorable in the observation group post-intervention (P < 0.05), indicating a reduction in inflammatory response. There was no significant difference in the incidence of postoperative adverse reactions between the groups (P > 0.05), suggesting that the comprehensive nursing interventions did not increase the risk of adverse effects. CONCLUSION: Comprehensive nursing interventions have a significant impact on the postoperative recovery outcomes of patients with LSS, alleviating pain, reducing inflammation levels, and improving the overall quality of patient recovery without increasing the patient burden. Therefore, in clinical practice, it is important to focus on comprehensive nursing interventions for patients with LSS to improve their recovery outcomes and quality of life.


Lumbar Vertebrae , Humans , Male , Female , Middle Aged , Lumbar Vertebrae/surgery , Treatment Outcome , Adult , Aged , Pain Measurement , Pain, Postoperative/etiology , Pain, Postoperative/rehabilitation , Disability Evaluation , Postoperative Care/methods
3.
Clin Nutr ESPEN ; 61: 181-188, 2024 Jun.
Article En | MEDLINE | ID: mdl-38777431

BACKGROUND & AIMS: Exploration whether Motivational Interviewing (MI) could be learned and implemented with ease within a surgical in-hospital setting and whether participation in the intervention led to significantly higher compliance with ERAS®-recommended protein intake goals. The individual healing process of many patients is delayed because they fail to cover their calorie requirement, which could be counteracted by a patient-centered conversational intervention that is new in perioperative practice. METHODS: This patient-blinded pilot-RCT included 60 patients (≥18 years) following the certified ERAS® bowel protocol for colorectal surgery between March and August 2022. Five perioperative MI interventions were conducted by two health employees certified to perform MI. Key endpoints were the number of protein shakes drunk, calories of proteins ingested and overall calorie intake. RESULTS: A total of 60 patients (34 men [56.7%]; mean [SD] age, 60.7 [13.3] years) were randomized. MI patient-group had significantly higher protein shake intake on all postoperative days except day 3. For days 0-3 MI group drank significantly more shakes overall (median 5.5 vs. 2.0; P = 0.004) and consumed more calories (median 1650.0 vs. 600.0 kcal; P = 0.004) and proteins (median 110.0 vs. 40.0 g; P = 0.005). Total calorie intake for each day by shakes and dietary intake was significantly higher in the MI-intervention group on day 2 (mean 1772.3 vs. 1358.9 kcal; P = 0.03). CONCLUSIONS: MI may contribute to improve compliance with nutritional goals in the certified ERAS® protocol by increasing protein and calorie intake. The findings suggest further investigation of MI to help patients achieve their perioperative nutrition goals in different clinical settings. TRIAL REGISTRATION: DRKS - Deutsches Register Klinischer Studien; DRKS-ID: DRKS00027863; https://drks.de/search/de/trial/DRKS00027863.


Elective Surgical Procedures , Enhanced Recovery After Surgery , Motivational Interviewing , Nutritional Status , Humans , Pilot Projects , Male , Female , Middle Aged , Aged , Energy Intake , Postoperative Period , Postoperative Care/methods , Dietary Proteins/administration & dosage , Goals
4.
Khirurgiia (Mosk) ; (5): 75-85, 2024.
Article Ru | MEDLINE | ID: mdl-38785242

OBJECTIVE: Investigation of the clinical and economic advisability of using self-adhesive wound bandages of plaster type (on the example of Cosmopor E steril) compared to gauze bandages in the conditions of medical organization. METHODS: Study design - a retrospective analysis of literature data. Methods of pharmacoeconomic analysis - cost minimization analysis, «impact on budget¼ analysis. The Unified Information System in Procurement was the information source of the self-adhesive bandages cost. The charges of gauze bandages production were calculated on the basis of data provided by structural subdivisions of SamSMU Clinics. RESULTS: It was determined that the use of self-adhesive bandages of plaster type is economically feasible as a result of the analysis of cost minimization and impact on the budget. Saving during 1 year can be from 259 466 to 532 603 rubles (in total for three departments - 1.1 million rubles). Sensitivity analysis showed the stability of the obtained results to the variation of entry conditions (costs for gauze bandages and bandages of plaster type) in a wide range of values. CONCLUSION: The data obtained from the study showed that the use of bandages of plaster type for different types of surgical treatment is more justified in terms of cost saving.


Bandages , Humans , Bandages/economics , Retrospective Studies , Russia , Postoperative Care/methods , Postoperative Care/economics , Cost-Benefit Analysis , Wound Healing/physiology
5.
J Orthop Surg Res ; 19(1): 307, 2024 May 21.
Article En | MEDLINE | ID: mdl-38773539

OBJECTIVE: This study aimed to evaluate the effectiveness of massage for postoperative rehabilitation after total knee arthroplasty (TKA). DATA SOURCES: The PubMed, Web of Science, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were systematically searched from inception to May 2024. STUDY SELECTION: Any randomized controlled trials on the use of massage for postoperative TKA rehabilitation were included. DATA EXTRACTION: A meta-analysis of outcomes, including postoperative pain, knee range of motion (ROM), postoperative D-dimer levels, and length of hospital stay, was performed. The Cochrane Risk of Bias Assessment Tool was used to assess the risk of bias, and the data for each included study were extracted independently by two researchers. DATA SYNTHESIS: Eleven randomized controlled clinical trials with 940 subjects were included. The results showed that compared with the control group, the massage group experienced more significant pain relief on the 7th, 14th and 21st days after the operation. Moreover, the improvement in knee ROM was more pronounced on postoperative days 7 and 14. In addition, the massage group reported fewer adverse events. However, there was no statistically significant difference in the reduction in postoperative D-dimer levels between the patients and controls. Subgroup analysis revealed that massage shortened the length of hospital stay for postoperative patients in China but not significantly for patients in other regions. Nevertheless, the heterogeneity of the studies was large. CONCLUSIONS: Increased massage treatment was more effective at alleviating pain and improving knee ROM in early post-TKA patients. However, massage did not perform better in reducing D-dimer levels in patients after TKA. Based on the current evidence, massage can be used as an adjunctive treatment for rehabilitation after TKA.


Arthroplasty, Replacement, Knee , Length of Stay , Massage , Pain, Postoperative , Randomized Controlled Trials as Topic , Range of Motion, Articular , Arthroplasty, Replacement, Knee/rehabilitation , Humans , Massage/methods , Pain, Postoperative/rehabilitation , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Treatment Outcome , Female , Fibrin Fibrinogen Degradation Products/metabolism , Fibrin Fibrinogen Degradation Products/analysis , Male , Knee Joint/surgery , Postoperative Care/methods
6.
Injury ; 55(6): 111595, 2024 Jun.
Article En | MEDLINE | ID: mdl-38703573

OBJECTIVE: The utility of routine post-operative imaging in clinically asymptomatic patients is unclear. We sought to determine how frequently X-rays following operatively treated ankle fractures result in a change in management. DESIGN: Retrospective cohort study conducted with hospital electronic health record SETTING: Single level 1 trauma center in major urban city. PATIENTS/PARTICIPANTS: 193 patients with operatively treated ankle fractures at our institution between January 2020 and December 2021. MAIN OUTCOME MEASURES: Patient radiographs were categorized as surveillance X-rays and clinically indicated X-rays. Changes in management were defined as alteration in follow-up, deviation from standard post-operative protocols, or revision surgery. A logistic regression was performed looking at factors predicting whether an X-ray changes management. A cost analysis was also performed looking at the financial implications of asymptomatic surveillance of ankle fractures. RESULTS: 438 post-operative X-rays were found and included in analysis. Of these, 391 were considered surveillance X-rays and 47 clinically indicated. 23 X-rays were determined to have resulted in changes in management (18 clinically indicated, 5 taken in asymptomatic patients). The number of management changing X-rays was significantly higher in the clinically indicated group (p < 0.0001). The only factor associated with whether an X-ray changed management was whether the patient was symptomatic at the visit (p < 0.0001). Asymptomatic surveillance X-rays cost our institution 21,825.62 USD per year. CONCLUSIONS: Radiographs in clinically asymptomatic patients with operatively managed ankle fractures have a low likelihood of changing management. Such imaging represents costs to the healthcare system, increased time for patients during clinic visits, and radiation exposure. The use of screening radiographic studies remains commonplace because the risk of delayed diagnosis is great, and the goal of any surgeon should be the swift identification of complications in order to minimize patient morbidity. Future surveillance protocols should consider the findings of this and other studies on the use of screening radiographs and strike a careful balance between minimizing unnecessary imaging, maximizing early complication detection, and ensuring a personalized approach towards patient-level factors to optimize care and efficiency for both patient and health system. LEVEL OF EVIDENCE: Level III.


Ankle Fractures , Radiography , Humans , Ankle Fractures/surgery , Ankle Fractures/diagnostic imaging , Retrospective Studies , Female , Male , Middle Aged , Adult , Postoperative Care/methods , Fracture Fixation, Internal/methods , Aged , Postoperative Period , Trauma Centers
7.
Am J Nurs ; 124(6): 28-36, 2024 Jun 01.
Article En | MEDLINE | ID: mdl-38728133

ABSTRACT: When an ostomy care nurse is not available, bedside nurses must assume responsibility for providing necessary care and educating patients who undergo a urinary diversion. However, staff nurses often lack the necessary knowledge and experience to provide the best care, rehabilitation, and patient education. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery in order to help eliminate gaps in care, increase nurses' and patients' competence and confidence, and optimize patient outcomes and quality of life. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care.


Urinary Diversion , Humans , Urinary Diversion/nursing , Patient Education as Topic , Postoperative Care/nursing , Postoperative Care/methods , Quality of Life , Self Care , Male
8.
J Gastrointest Surg ; 28(5): 667-671, 2024 May.
Article En | MEDLINE | ID: mdl-38704204

BACKGROUND: The evolution of enhanced recovery pathways (ERPs) in colon and rectal surgery has led to the development of same-day discharge (SDD) procedures for selected patients. Early discharge after diverting loop ileostomy (DLI) closure was first described in 2003. However, its widespread adoption remains limited, with SDD accounting for only 3.2% of all DLI closures in 2005-2006, according to the American College of Surgeons National Surgical Quality Improvement Program database, and rising to just 4.1% by 2016. This study aimed to compare the outcomes of SDD DLI closure with those of DLI closure after the standard ERP. METHODS: A retrospective case-matched study compared 125 patients undergoing SDD DLI closure with 250 patients undergoing DLI closure after the standard ERP based on age (±1 year), sex, American Society of Anesthesiologists score, body mass index, surgery date (±2 months), underlying disease, and hospital site. The primary outcome was comparative 30-day complication rates. RESULTS: Patients in the traditional ERP group received more intraoperative fluids (1221.1 ± 416.6 vs 1039.0 ± 368.3 mL, P < .001) but had similar estimated blood loss. Ten patients (8%) in the SDD-ERP group failed SDD. The 30-day postoperative complication rate was significantly lower in the SDD group (14.8%) than the standard ERP group (25.7%, P = .025). This difference was primarily driven by a lower incidence of ileus in the SDD group (9.6% vs 14.8%, P = .034). There were no significant differences in readmission rate (9.6% of SDD-ERP vs 9.2% of standard ERP, P = .900) and reoperation rates (3.2% of SDD-ERP vs 2.4% of standard ERP, P = .650). CONCLUSION: SDD ileostomy closure is a safe, feasible, and effective procedure associated with fewer complications than the present study's standard ERP. This could represent a new standard of care. Further prospective trials are required to confirm the findings of this study.


Ileostomy , Patient Discharge , Postoperative Complications , Humans , Ileostomy/methods , Ileostomy/adverse effects , Male , Female , Retrospective Studies , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Patient Discharge/statistics & numerical data , Aged , Postoperative Care/methods , Patient Readmission/statistics & numerical data , Enhanced Recovery After Surgery , Treatment Outcome , Case-Control Studies , Length of Stay/statistics & numerical data
9.
Ophthalmologie ; 121(5): 427-437, 2024 May.
Article De | MEDLINE | ID: mdl-38683364

Excessive wound healing in filtering glaucoma surgery is a key factor for a failed surgery. After the introduction of trabeculectomy in the 1960s many factors associated with an increased fibrotic reaction were recognized and methods were developed to influence postoperative wound healing. These range from the perioperative use of anti-inflammatory drugs and antimetabolites to the use of newer chemical compounds that influence the morphology of postoperative fibroblast growth. In the routine clinical practice, the fine tuning of therapeutic decisions plays a decisive role in the success or failure of filtration surgery.


Glaucoma , Postoperative Care , Trabeculectomy , Wound Healing , Trabeculectomy/methods , Humans , Wound Healing/drug effects , Glaucoma/surgery , Postoperative Care/methods , Anti-Inflammatory Agents/therapeutic use , Postoperative Complications
10.
Heart Lung ; 66: 47-55, 2024.
Article En | MEDLINE | ID: mdl-38582067

BACKGROUND: Oxygen therapy constitutes a crucial element of post-cardiac operative care. The study assessed the effectiveness of high-flow nasal cannula (HFNC) in comparison to conventional oxygen therapy (COT). OBJECTIVES: The aim of the study was to assess the effectiveness of HFNC in comparison to COT for adult patients following cardiac surgery. METHODS: We conducted a comprehensive search of Embase, PubMed, Scopus, Cochrane Library, and Web of Science databases from inception until April 18, 2023, to identify randomized controlled trials (RCTs) and crossover studies that compared the efficacy of HFNC with COT in adult patients following cardiac surgery. RESULTS: The meta-analysis included nine studies, consisting of eight RCTs and one crossover study. Compared with COT, HFNC could reduce the need for escalation of respiratory support (RR 0.67, 95% CI: 0.48 to 0.93, P = 0.02), decrease arterial partial pressure of carbon dioxide (PaCO2) levels (MD -3.14, 95% CI: -4.90 to -1.39, P<0.001), and increase forced expiratory volume in 1 second (FEV1) levels (MD 0.08, 95% CI: 0.02 to 0.15, P = 0.02). There was no significant difference between the HFNC and COT groups in terms of mortality, intubation rate, respiratory rate, heart rate, intensive care unit and hospital length of stay, arterial partial pressure of oxygen (PaO2), forced vital capacity, and complications of atrial fibrillation and delirium. CONCLUSION: Compared with COT, HFNC could decrease the need for escalation of respiratory support, lower PaCO2 levels, and elevate FEV1 levels in patients following cardiac surgery.


Cannula , Cardiac Surgical Procedures , Oxygen Inhalation Therapy , Adult , Humans , Cardiac Surgical Procedures/methods , Oxygen Inhalation Therapy/methods , Oxygen Inhalation Therapy/instrumentation , Postoperative Care/methods
11.
Injury ; 55(6): 111518, 2024 Jun.
Article En | MEDLINE | ID: mdl-38614834

INTRODUCTION: Post-operative pelvic & acetabular fixation patients are conventionally imaged using 3-view radiographs (AP, inlet and outlet). The efficacy of such radiographs is inconsistent due to technical difficulties capturing an adequate view, often necessitating repeat radiographs and therefore increasing radiation exposure. Radiographs can be difficult to interpret, limiting the assessment of fracture reduction and fixation, especially with respect to metalwork positioning around articular surfaces. Traditionally, post-operative pelvic & acetabular fixation patients undergo repeat 3-view radiographs post-operatively, at 6 weeks, followed by at 3, 6, 12, 18 and 24 months. We propose a new pathway, in which patients have one low-dose pelvic CT immediately post-operatively, followed by one radiograph (AP pelvis) at the same time points. METHODS: A new pelvic CT protocol was created to provide high quality 3D imaging whilst delivering a 5 times lower radiation dose (compared to normal pelvic CT). Data for all pelvic radiographs and CTs between January 2021 and March 2022 was exported. Using dose area product values, effective radiation dose and attributable lifetime cancer risk were calculated. RESULTS: There were 42 patients included in the analysis (age range 15 to 87).The average effective dose for the 3-view pelvic X-rays was 0.6mSv (range 0.2 to 2.8mSv), and 1.1mSv (range 0.5 to 2.2mSv) for the low-dose pelvic CT. Traditional 7 × 3-view post-operative radiographs: 7 × 0.6mSv = 4.2mSv (corresponding to 1 in 11,000 cancer risk) Low dose post-operative CT and 6 × 1-view radiographs: 1.1mSv + (6 × 0.6mSv / 3) = 2.3mSv (corresponding to 1 in 20,000 cancer risk) CONCLUSION: Low-dose CT scanning (in conjunction with 1-view radiographs) is an effective and safe imaging modality in the post-operative assessment of pelvic & acetabular fracture fixation, conferring a lower radiation burden, easier logistics, and higher quality images when compared to the traditional pathway of 3-view radiographs.


Acetabulum , Fracture Fixation, Internal , Fractures, Bone , Pelvic Bones , Radiation Dosage , Tomography, X-Ray Computed , Humans , Acetabulum/surgery , Acetabulum/diagnostic imaging , Acetabulum/injuries , Female , Male , Middle Aged , Adult , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Aged , Pelvic Bones/diagnostic imaging , Pelvic Bones/injuries , Pelvic Bones/surgery , Adolescent , Aged, 80 and over , Fracture Fixation, Internal/methods , Young Adult , Imaging, Three-Dimensional , Postoperative Care/methods , Retrospective Studies , Postoperative Period , Radiation Exposure
12.
Aliment Pharmacol Ther ; 59(12): 1579-1588, 2024 Jun.
Article En | MEDLINE | ID: mdl-38616417

BACKGROUND: Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course. AIM: To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD. METHODS: We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation. RESULTS: Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively. CONCLUSION: Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.


Crohn Disease , Reoperation , Humans , Crohn Disease/surgery , Crohn Disease/drug therapy , Female , Male , Reoperation/statistics & numerical data , Adult , Retrospective Studies , Middle Aged , Immunosuppressive Agents/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Postoperative Care/methods , Young Adult , Kaplan-Meier Estimate , Time Factors , Proportional Hazards Models
13.
Bull Cancer ; 111(5): 496-504, 2024 May.
Article Fr | MEDLINE | ID: mdl-38553286

The management of head and neck cancers is multidisciplinary, often relying on the use of combined treatments to maximize the chances of cure. Combined treatments are however also responsible for cumulative side effects. The aim of reconstructive surgery with a flap is to restore a function lost with the loss of substance from the tumor resection. However, changes in reconstructive surgery have impact of postoperative radiotherapy planning. The optimization of imaging protocols for radiotherapy planning should make it possible to identify postoperative changes and to distinguish flaps from surrounding native tissues to delineate the flaps and document the spontaneous evolution of these flaps or dose-effect relationships in case of radiotherapy. Such changes include atrophy, fibrosis of soft tissue flaps and osteoradionecrosis of bone flaps. Radiotherapy optimization also involves standardization of the definition of target volumes in situations where a flap is present, a situation that is increasingly common in routine care. This evolution of practice, beyond the essential multidisciplinary consultation meetings defining treatment indications, requires a close radio surgical collaboration with respect to technical aspects of the two disciplines. Doing so, anticipation of relapse and toxicity profiles could possibly lead to propose strategies for personalized de-escalation of multimodal treatments through interdisciplinary trials.


Head and Neck Neoplasms , Plastic Surgery Procedures , Surgical Flaps , Humans , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Plastic Surgery Procedures/methods , Osteoradionecrosis/etiology , Osteoradionecrosis/surgery , Postoperative Care/methods , Fibrosis , Radiotherapy, Adjuvant/adverse effects , Radiotherapy, Adjuvant/methods , Radiotherapy Planning, Computer-Assisted/methods
14.
Pediatr Cardiol ; 45(5): 1129-1131, 2024 Jun.
Article En | MEDLINE | ID: mdl-38522051

The study aimed to evaluate the feasibility of using QR code-enabled medical bracelets for congenital heart disease (CHD) patients after hospital discharge to ensure quick communication of vital information to other medical personnel in emergency situations. A prospective study was conducted where QR code-enabled medical bracelets were given to families of postoperative pediatric cardiac patients. The QR code linked to a secure medical information sheet detailing the patient's cardiac history. Post-study surveys were completed by providers and families to assess their experiences with the bracelet. Of the 20 participants enrolled, 65% used the QR bracelet when seeking medical care. 55% found the bracelet useful, and 70% rated their experience as either "positive" or "very positive". Additionally, 80% recommended the bracelet for other patients undergoing cardiac procedures. The use of QR code bracelets for postoperative CHD patients has shown high levels of satisfaction from families and providers, potentially reducing medical errors and treatment delays.


Heart Defects, Congenital , Humans , Heart Defects, Congenital/therapy , Heart Defects, Congenital/surgery , Pilot Projects , Prospective Studies , Female , Male , Postoperative Care/methods , Child , Feasibility Studies , Child, Preschool , Cardiac Surgical Procedures , Infant , Patient Discharge , Surveys and Questionnaires
15.
Int Urol Nephrol ; 56(6): 1795-1801, 2024 Jun.
Article En | MEDLINE | ID: mdl-38305938

OBJECTIVE: To evaluate the efficacy of different dressing methods in wound healing and the postoperative outcome in children who underwent hypospadias repair. METHODS: Altogether 109 children with distal hypospadias who underwent urethroplasty were recruited from our hospital between January 2021 and March 2023. All patients were randomized in two groups according to the different dressing methods: Group A receiving 3 M antimicrobial incise drape + MEBO (moisture-exposed burn ointment) and Group B receiving absorbent dressing + elastic bandage dressing. The age at surgery, operation time, bleeding during the dressing, postoperative changes in glans color, dressing fell off, comfort of children during the dressing, difficulty in dressing removal, and degree of pain during dressing removal were compared between the two groups. RESULTS: Differences in age at surgery (p = 0.337) and operation time (p = 0.055) were not significant between the two groups. The overall effectiveness of the dressing was better in Group A than that in Group B. Only five cases in Group A had blood leakage after dressing (p = 0.006), and there was no dressing dislocation (p < 0.001) or glans color abnormality (p < 0.001). Moreover, the number of complication cases was less. The overall comfort and pain degree during dressing removal in Group A was better than that in Group B (p < 0.001). CONCLUSION: Postoperative dressing using 3 M antimicrobial incise drape + MEBO can achieve lower incidence rates of bleeding during dressing, postoperative glans darkening, and dressing falling off, a lower pain degree during dressing removal, and a better overall comfort level than those of the control group. This method is cost-effective and clinically safe, which contributes to the postoperative recovery of children with hypospadias and is thus worth promoting and applying.


Bandages , Hypospadias , Wound Healing , Humans , Hypospadias/surgery , Male , Child, Preschool , Infant , Urologic Surgical Procedures, Male/methods , Postoperative Care/methods
16.
Clin Rehabil ; 38(6): 732-748, 2024 Jun.
Article En | MEDLINE | ID: mdl-38321770

OBJECTIVE: To report the treatment effects of early use kinesiotaping on pain, range of motion, mobility, and edema outcomes following total knee arthroplasty. DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMED, SPORTDiscus, Biosis Citation Index, and the Cumulative Index to Nursing and Allied Health Literature were searched for potential randomized control trials from inception to 8 January 2024. REVIEW METHODS: Randomized control trials evaluating the effect of kinesiotaping published in English were included. Reference lists for relevant reviews were searched. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Seven articles totaling 534 participants were included for meta-analysis. Kinesiotaping with standard rehabilitation when compared to standard rehabilitation alone had very low certainty of evidence in pain and knee flexion range of motion. Kinesiotaping was favored at post-operative days two to four for pain (P = 0.03, standard mean difference = -0.77 [-1.45, -0.09]) and range of motion (P = 0.002, standard mean difference = -0.24 [-0.44, -0.03]). Kinesiotaping was favored at post-operative days six to eight for pain (P = 0.02, standard mean difference = -0.76 [-1.41, -0.12]) and range of motion (P = 0.04, standard mean difference = -0.63 [-1.22, -0.04]). Edema and mobility could not be meta-analyzed. CONCLUSION: The use of kinesiotaping early in post-operative rehabilitation could be a useful modality for reducing pain and increasing the range of knee flexion, however, the certainty of evidence is very low.


Arthroplasty, Replacement, Knee , Athletic Tape , Randomized Controlled Trials as Topic , Range of Motion, Articular , Humans , Arthroplasty, Replacement, Knee/rehabilitation , Postoperative Care/methods
18.
Am Surg ; 90(6): 1290-1297, 2024 Jun.
Article En | MEDLINE | ID: mdl-38243794

BACKGROUND: Surgical resection is a mainstay of treatment in high-risk neuroblastoma (HR-NB), but there exists wide variability in perioperative management practices. The aim of this study was to evaluate two standardized adult perioperative enhanced recovery practices (ERPs) in pediatric patients undergoing open resection of abdominal HR-NB. METHODS: All patients with abdominal HR-NB surgically resected at a free-standing children's hospital between 12/2010 and 7/2020 were retrospectively reviewed. Perioperative ERPs of interest included avoidance of routine nasogastric tube (NGT) use and the use of neuraxial anesthesia. Primary outcomes included time to enteral intake, urinary catheter use, opioid utilization, and length of stay (LOS). RESULTS: Overall, 37 children, median age 33 months (IQR: 20-48 months), were identified. Avoidance of an NGT allowed for earlier feeding after surgery (P = .03). Neuraxial anesthesia use more frequently required an indwelling urinary catheter (P < .01) for a longer duration (P = .02), with no difference in total opioid utilization (P = .77) compared to patients without neuraxial anesthesia. Postoperative LOS was unaffected by avoidance of routine NGT use (P = .68) or use of neuraxial anesthesia (P = .89). CONCLUSION: Children undergoing open resection of abdominal HR-NB initiated diet sooner when an NGT was not left postoperatively, and the need for a urinary catheter was significantly higher in patients who received neuraxial anesthesia. However, these two ERP components did not decrease postoperative LOS. To optimize the postoperative management of NB patients, postoperative NGTs should be avoided, while the benefit of neuraxial anesthesia is less clear as it necessitates the placement of a urinary catheter without decreasing opioid utilization.


Length of Stay , Neuroblastoma , Humans , Neuroblastoma/surgery , Male , Female , Retrospective Studies , Child, Preschool , Infant , Length of Stay/statistics & numerical data , Postoperative Care/methods , Abdominal Neoplasms/surgery , Enhanced Recovery After Surgery , Analgesics, Opioid/therapeutic use , Intubation, Gastrointestinal , Urinary Catheterization
20.
Am Surg ; 90(6): 1731-1733, 2024 Jun.
Article En | MEDLINE | ID: mdl-38215041

Laparoscopic common bile duct exploration (LCBDE) utility in management of choledocholithiasis may decrease length of stay and patient cost, but postoperative management remains widely debated. We examined periprocedural LFTs for patients undergoing LCBDE and endoscopic retrograde cholangiopancreatography (ERCP) speculating for trend existence after successful LCBDE. We hypothesized that postoperative LCBDE LFTs would not downtrend even after successful ductal clearance. We identified 99 patients under 18 who underwent ERCP or LCBDE with at least one pre- and post-procedural LFT. Periprocedural LFTs between groups were compared using Wilcoxon signed-rank tests. The 22 ERCP patients demonstrated a significant downtrend across Tbili (P < .001), AST (P = .001), ALT (P = .002), and ALP (P < .001). The 27 LCBDE patients demonstrated a significant downtrend in Tbili (P = .002) only, while AST (P > .05), ALT (P > .05), and ALP (P > .05) were nonsignificant. Lack of consistent downtrend in the LCBDE group raises doubt regarding the utility of postoperative LFTs for post-procedural management.


Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Common Bile Duct , Laparoscopy , Humans , Choledocholithiasis/surgery , Child , Female , Male , Common Bile Duct/surgery , Adolescent , Retrospective Studies , Child, Preschool , Liver Function Tests , Postoperative Care/methods
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