ABSTRACT
INTRODUCTION: Arthroplasty procedures are commonly performed in the UK. Informed consent is required for each procedure. To obtain informed consent the patient and their surgeon should discuss the risks and benefits of the proposed operation. This discussion should include both regional and systemic complication rates. Regional complications of arthroplasty are generally well documented in the literature. Systemic medical complications are less well described. This lack of accurate data could make it difficult for the treating surgeon to obtain valid consent. The aim of this paper was to review and compare the literature regarding the rate of systemic medical complications after common arthroplasty procedures. METHODS: A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies regarding the systemic medical complications and mortality rate of joint replacement were included. FINDINGS: We found that systemic complications were more frequent than regional complications following arthroplasty. The systemic complication rates were: hip, 5.1%; knee, 6.9%; ankle, 3.0%; shoulder, 11.2%; elbow, 8.5%; and wrist, 0%. Mortality rates for arthroplasty procedures were: hip, 0.3%; knee, 0.2%; ankle, 0.3%; shoulder, 0.3%; elbow, 0.2%; and wrist, 0%. CONCLUSIONS: The most common systemic medical complication following arthroplasty was venous thromboembolism. Preoperative comorbidity was the most important risk factor for both postoperative mortality and systemic medical complications following arthroplasty procedures. We recommend that to obtain informed consent the given rates of systemic medical complications of joint replacement should be discussed and documented.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Humans , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Informed Consent , Risk FactorsABSTRACT
Surgeons and anaesthetists work closely together, sometimes in challenging circumstances. To help surgeons cooperate with anaesthetists to deliver high quality care for patients, a working knowledge of modern anaesthetic practice is useful. The specialty of anaesthetics is developing rapidly, and periodic updating of this knowledge is likely to be required. This article provides an update of anaesthetic practice for surgeons, covering the varied roles of anaesthetists, preoperative assessment, management on the day of surgery (induction, maintenance and reversal of anaesthetic), general anaesthesia, the role of regional blocks and sedation. It also discusses safety issues, the management of frail patients and future challenges.
Subject(s)
Anesthesiology , General Surgery/education , Interdisciplinary Communication , Interdisciplinary Placement/methods , Anesthesia, Conduction/methods , Anesthesia, General/methods , Anesthesiology/education , Anesthesiology/methods , Humans , Surgical Procedures, Operative/methodsABSTRACT
Regional anaesthesia is widely used in modern anaesthetic practice for perioperative and postoperative analgesia. In the operating theatre, regional anaesthesia is used both on its own and in combination with other techniques (general anaesthesia and sedation). Regional anaesthesia is now a core skill set in anaesthetic training. This article provides a basic outline of regional anaesthesia for surgeons and other non-anaesthetic staff working with anaesthetists, reviewing preparation, consent, basic and specialist equipment, central neuraxial blocks (spinal, epidural and caudal), trunk blocks, upper limb blocks (interscalene, supraclavicular, infraclavicular and axillary) and lower limb blocks (femoral, fascia iliaca, sciatic, popliteal and ankle). It also discusses the pharmacology of the agents used and common complications.
Subject(s)
Anesthesia, Conduction , Anesthesia, Conduction/methods , Anesthesia, Local/methods , Humans , Nerve Block/methods , Pain, Postoperative/therapy , Perioperative Care/methodsABSTRACT
We evaluated the Vitek system for bacterial identification and susceptibility testing with reference to its speed, staffing requirements, user friendliness, and data management. Its performance was satisfactory in all these dimensions, but it is expensive.
Subject(s)
Bacteriological Techniques/instrumentation , Expert Systems , Microbial Sensitivity Tests/instrumentation , Microcomputers , Bacteria/classification , Bacteria/isolation & purification , Humans , Sensitivity and SpecificitySubject(s)
Managed Care Programs/trends , Telemedicine/trends , Costs and Cost Analysis/trends , Income , Managed Care Programs/organization & administration , Marketing of Health Services/organization & administration , Marketing of Health Services/trends , Outcome Assessment, Health Care , Patient Admission/trends , Telemedicine/organization & administration , Triage/standards , Triage/trends , United StatesABSTRACT
Accurate and reliable documentation of rights restrictions is critical for evaluating a program's success against the intrusiveness of a behavioral intervention, complying with regulatory standards, and refining treatment strategies. Direct-care and ancillary staff in three cottages at a state facility for persons with mental retardation were selected to evaluate a revised documentation system, including a new form, inservice training for staff inservice, and staff feedback, that was implemented sequentially across cottages. Results showed an immediate and sustained reduction in documentation errors following the implementation of the documentation system. Benefits and limitations of the new system were discussed.
