Revisión sistemática de intervenciones de fisioterapia respiratoria y sus efectos en la función pulmonar en pacientes obesos intervenidos de cirugía bariátrica / Systematic review of Respiratory Physiotherapy interventions and their effects on lung function in obese patients operated of bariatric surgery

Introducción La incidencia de obesidad alcanza casi un tercio de la población mundial. En España habrá más de 27 millones de personas con obesidad para 2030, suponiendo una enorme carga socioeconómica, obligando a realizar intervenciones como la cirugía bariátrica (CB) que también tiene sus complicaciones. En los últimos años ha existido un avance de técnicas de fisioterapia respiratoria (FR) por ejemplo, empleando ejercicios respiratorios o utilizando presión positiva (PP). Objetivo Revisar sistemáticamente las intervenciones de FR en CB centrándonos en el tipo de intervención, momento y sus efectos sobre la función pulmonar. Metodología Se realizó la búsqueda en las bases PubMed, CINAHL y PEDro hasta marzo del 2022. Se incluyeron estudios de intervenciones de FR, que midieran la función pulmonar, en contexto pre-posquirúrgico de CB. Se excluyeron los trabajos que no aportaran datos originales, intervención no realizada por fisioterapeutas o que no miden función respiratoria. La calidad metodológica de los estudios se evaluó con la escala PEDro y JBI cheklist for cohort studies. Resultados Fueron incluidos 16 documentos, 20% presentó excelente calidad metodológica y 50% buena. El tamaño muestral varió entre 24 y 148, al igual que la edad (entre 18-60 años) incluso alcanzando 75 años en algún estudio, predominando el género femenino. El tipo de intervenciones (manuales, instrumentales o educacionales), momento de aplicación (pre y posquirúrgicas) y resultados evaluados fueron muy heterogéneos. Conclusiones Existe gran variabilidad de intervenciones de fisioterapia en CB, la mayoría (75%) mejoran la función pulmonar, otras indican falta de eficacia y algunas no indican cambios (AU)

Introduction The incidence of obesity reaches almost a third of the world population. In Spain, there will be more than 27 million people with obesity in 2030. Assuming an enormous socioeconomic burden, forcing interventions such as bariatric surgery, whit their complications. In recent years, there has been an advance in Respiratory Physiotherapy (RP) techniques, for example, using breathing exercises or using positive pressure (PP). Objective To systematically review RP interventions in bariatric surgery, focusing on the type of intervention, timing, and its effects on lung function. Methodology PubMed, CINAHL and PEDro databases were searched until March 2022. RP emergency studies were included, which measured lung function, in the pre-post-surgical context of bariatric surgery. Studies that did not provide original data, intervention not performed by physiotherapists or that did not measure respiratory function were excluded. The methodological quality of studies was evaluated with the PEDro scale and the JBI checklist for cohort studies. Results 16 documents were included, 20% presented excellent methodological quality and 50% good. The sample size varied between 24 and 148 and age (between 18-60 years), even reaching 75 years in some studies, with the female gender predominating. The type of outbreak (manual, instrumental or educational), time of application (pre and post-surgery) and results evaluated were very heterogeneous. Conclusions There is a high variability in physiotherapy interventions used in bariatric surgery, most (75%) improve lung function, others indicate lack of efficacy and some do not indicate changes (AU)

Sinking bone flap due to overdrainage of a ventriculoperitoneal shunt. A case report and review of the literature / Hundimiento de colgajo óseo por sobredrenaje de una derivación ventriculoperitoneal. Caso clínico y revisión de la literatura

The widespread use of decompressive craniectomy and subsequent cranioplasty has led to a better understanding of its complications. However, cases of a sunken bone flap have hardly ever been described. We present the eighth case reported up to date and perform a review of the literature of this sporadic complication. A 40-year-old Caucasian male suffered a traumatic brain injury that required a decompressive craniectomy. One month after initial trauma autologous cranioplasty was performed. A ventriculoperitoneal shunt was also placed. Neurological status progressively improved but his therapist noted cognitive status decline 8 months later. Follow-up computed tomography showed a progressive sinking bone flap. The patient underwent bone flap removal and a custom-made calcium phosphate-based implant was inserted, leading to symptoms resolution. Bone resorption has been described as the main cause of sinking bone flap following cranioplasty. This entity may manifest with symptoms of overdrainage in patients with cerebrospinal fluid shunt devices (AU)

El uso extendido de la craniectomía descompresiva y la consiguiente craneoplastia ha propiciado un mejor conocimiento de sus complicaciones. Sin embargo, esporádicamente se han descrito casos de hundimiento del colgajo óseo. Describimos el octavo caso descrito hasta la fecha y realizamos una revisión de la literatura de esta infrecuente complicación. Un varón de 40 años sufrió un traumatismo craneoencefálico que requirió craniectomía descompresiva. Un mes después se sometió a la reposición de su colgajo óseo, junto con la implantación de una derivación ventriculoperitoneal. Presentó mejoría neurológica progresiva que se frenó y empeoró ocho meses después. La tomografía computarizada de control mostró hundimiento progresivo del colgajo óseo. El paciente se sometió a la retirada del colgajo óseo y cranioplastia con implante a medida, con resolución de los síntomas. La resorción ósea se ha descrito como la principal causa del hundimiento del colgajo óseo tras cranioplastia. Sin embargo, esta entidad puede manifestarse como síntomas de sobredrenaje en pacientes con derivación de líquido cefalorraquídeo (AU)

Intestinal and Multivisceral Transplantation: Complications.

Advancements in immunosuppression protocols, surgical techniques, and postoperative care in the last few decades have improved outcomes of intestinal transplant patients. Normal immediate postoperative imaging appearance can simulate pathology. Intestinal transplant recipients are prone for several postoperative complications due to the complex surgical technique, which involves multiple anastomoses, and immunogenic nature of the allograft intestine. Imaging plays a crucial role in detection of several major complications including infectious, immunologic, vascular, gastrointestinal, pancreaticobiliary, genitourinary, and neoplastic complications. The awareness of the posttransplant anatomy and normal imaging appearances helps radiologists anticipate and accurately detect posttransplant complications.

Cuidados de enfermería para personas sometidas a cirugía bariátrica: revisión integradora / Cuidados de enfermagem às pessoas submetidos à cirurgia bariátrica: revisão integrativa / Nursing care for people undergoing bariatric surgery: integrative review

Objetivo: Identificar a partir de la literatura científica los cuidados de Enfermería brindados a personas con obesidad sometidas a cirugía bariátrica. Método: Revisión integrativa de la literatura, se realizaron búsquedas de julio a agosto/2021 en cuatro bases de datos: MEDLINE, LILACS, BDENF y EMBASE. La pregunta de investigación fue delimitada a través de la estrategia PICo, considerando: P – Pacientes con obesidad; I - Atención de Enfermería; Co – Pacientes obesos sometidos a cirugía bariátrica. Se elaboró la siguiente pregunta: “¿Cuáles son los principales cuidados de Enfermería en pacientes con obesidad sometidos a cirugía bariátrica?”. Criterios de inclusión artículos primarios que cumplieron con la pregunta orientadora; disponible en su totalidad; durante el período de 2016 a 2021; Idiomas portugués, inglés y español. Criterios de exclusión literatura gris, estudios que no respondieron a la pregunta orientadora. Los resultados de la búsqueda fueron analizados e interpretados. Resultados: 14 artículos fueron incluidos en la síntesis de la investigación. El análisis de los resultados mostró que los cuidados de Enfermería prestados a las personas sometidas a cirugía bariátrica fueron identificados en el período preoperatorio: educación en salud sobre el procedimiento quirúrgico y posibles complicaciones; y en el postoperatorio: pautas para aliviar la ansiedad. En el período intraoperatorio no se mencionaron los procedimientos de atención. Conclusión: Considerando, por lo tanto, la presentación de resultados, los hallazgos demuestran la inequívoca necesidad e importancia de incorporar nuevas tecnologías en el cuidado de Enfermería; promover la formación de habilidades y destrezas de los integrantes del equipo, además de realizar nuevas investigaciones que permitan ampliar la actuación del equipo de Enfermería en el cuidado de los pacientes sometidos a cirugía bariátrica. (AU)

Objetivo: Identificar a partir da literatura científica os cuidados de Enfermagem prestados as pessoas com obesidade submetidas à cirurgia bariátrica. Método: Revisão integrativa da literatura, buscas foram realizadas em julho a agosto/2021 em quatro bases de dados: MEDLINE, LILACS, BDENF e EMBASE. Delimitou-se a questão de pesquisa por meio da estratégia PICo, considerada: P – Pacientes com obesidade; I – Cuidados de Enfermagem; Co – Obesos submetidos à cirurgia bariátrica. Elaborou-se a seguinte questão: “Quais os principais cuidados de Enfermagem em pacientes com obesidade que foram submetidos à cirurgia bariátrica?”. Critérios de inclusão artigos primários que atenderam a questão norteadora; disponíveis na íntegra; durante o período de 2016 a 2021; idiomas português, inglês e espanhol. Critérios de exclusão literaturas cinzentas, estudos que não respondessem à questão norteadora. Os resultados das buscas foram analisados e interpretados. Resultados: Foram incluídos 14 artigos na síntese da pesquisa. Análise dos resultados permitiu evidenciar que os cuidados de Enfermagem prestados às pessoas submetidas à cirurgia bariátrica foram identificados nos períodos pré-operatório: educação em saúde quanto ao procedimento cirúrgico e possíveis complicações; e no pós-operatório: orientações para aliviar ansiedade. No período intraoperatório, não foram citados quais cuidados são realizados. Conclusão: Considerando, portanto, a exposição dos resultados, os achados demonstram a inequívoca necessidade e a importância da incorporação de novas tecnologias nos cuidados de Enfermagem; promover a capacitação das competências e habilidades dos integrantes da equipe, além da realização de novas pesquisas que permitam ampliar a atuação da equipe de Enfermagem no atendimento a pacientes submetidos à cirurgia bariátrica. (AU)

Objective: To identify from the scientific literature the Nursing care provided to people with obesity undergoing bariatric surgery. Method: Integrative literature review, searches were carried out from July to August/2021 in four databases: MEDLINE, LILACS, BDENF and EMBASE. The research question was delimited through the PICo strategy, considering P – Patients with obesity; I – Nursing care; Co – Obese patients undergoing bariatric surgery. The following question was elaborated: “What are the main Nursing care in patients with obesity who underwent bariatric surgery?”. Inclusion criteria primary articles that met the guiding question; available in full; during the period from 2016 to 2021; Portuguese, English and Spanish languages. Exclusion criteria gray literature, studies that did not respond to the guiding question. Search results were analyzed and interpreted. Results: 14 articles were included in the research synthesis. Analysis of the results showed that the Nursing care provided to people undergoing bariatric surgery was identified in the preoperative period: health education regarding the surgical procedure and possible complications; and in the postoperative period: guidelines for relieving anxiety. In the intraoperative period, care procedures were not mentioned. Conclusion: Considering, therefore, the presentation of results, the findings demonstrate the unequivocal need for and importance of incorporating new technologies in Nursing care; promote the training of skills and abilities of team members, in addition to carrying out new research that allows expanding the performance of the Nursing team in the care of patients undergoing bariatric surgery. (AU)

Die Komplexität handchirurgischer Therapien im Kontext sektorenübergreifender Versorgungskonzepte: Konsensusempfehlung der Deutschen Gesellschaft für Handchirurgie.

Overboarding politcal influence in Germany concerning medical issues has come to a new peak. The report by the IGES Institute published in 2022 made an important contribution in this regard. Unfortunately, only that part of the recommendations of this report were implemented in a new version of the contract for outpatient surgery according to Section 115b SGB V (AOP contract), that called for an expansion of outpatient surgery. In particular, those aspects that are important from a medical point of view for a patient-specific adjustment of outpatient surgery (e. g. old age, frailty, comorbidities) as well as the important structural requirements for outpatient postoperative care were included in the new AOP contract at best in a rudimentary manner. For this reason, the German Society for Hand Surgery felt compelled to give its members a recommendation as to which medical aspects must be taken into account, especially when performing hand surgery operations, in order to ensure the highest level of safety for the patients entrusted to us while performing outpatient surgery. An expert group of experienced hand surgeons and hand therapists who work in hospitals of all levels of care as well as resident surgeons was formed in order to formulate mutually agreed recommendations for action.

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care.

BACKGROUND: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care. METHODS: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. RESULTS: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. CONCLUSIONS: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge.

INTRODUCTION: Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. METHODS: A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. RESULTS: In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. CONCLUSION: A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.

Perioperative visits in minimally invasive gynecologic surgery.

PURPOSE OF REVIEW: Perioperative visits for gynecologic surgery patients have traditionally included in-person examinations and counseling, but the advent of telemedicine has prompted clinicians to consider varying approaches to perioperative care. We aim to educate readers on the optimal setting and context of perioperative visits and provide insight from our experience to optimize care. RECENT FINDINGS: The widespread adoption of telemedicine and a focus on equity and access has prompted gynecologic surgeons to reconsider traditional preoperative and postoperative visits. SUMMARY: This review summarizes evidence for new approaches to perioperative care for minimally invasive gynecologic surgery, including transition to telemedicine for preoperative and postoperative care, adjuvant tools for perioperative counseling, and the value of in-person visits for preoperative planning.

Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials.

BACKGROUND: Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient's recovery. OBJECTIVES: We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. METHODS: We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non-English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included "good quality" RCTs with Jadad score ≥ 3 for data extraction and synthesis. RESULTS: Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. CONCLUSIONS: The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery.

Optimizing post-operative imaging: a retrospective cohort study comparing two methods of lateral hip radiography after cephalomedullary nail surgery.

BACKGROUND: Currently, there is no consensus on the most appropriate technique for obtaining lateral hip radiographs after cephalomedullary nail (CMN) surgery. The aim of this study was to investigate the distribution of two commonly used postoperative lateral hip radiographic methods (classic lateral view and modified lateral view) and try to find out which one is better suited for this situation. METHODS: A retrospective analysis was conducted on 146 patients who underwent surgical fixation for extracapsular hip fractures between January 2018 and June 2022. The main outcome measured was the angle between the straight part of the CMN and the lag screw/blade on hip lateral X-rays (CMNA). The lateral hip radiographs were categorized into two groups based on different lateral hip radiographic methods. CMNA, patient age, gender, fracture classification based on the 2018 AO classification, nail length (short/long), surgical side (left/right), height, weight, BMI, preoperative waiting time, postoperative imaging interval were collected and compared between the two groups. RESULTS: The distribution trend of CMNA significantly differs between two types of hip joint lateral radiographic methods. Specifically, the classic lateral method exhibits a significantly bimodal and skewed distribution with a median (p25, p75) of -21.6° (-31.2°, -8°), whereas the modified lateral method presents a normal distribution with a mean ± SD of +7.57° ± 14.4°. The difference in the Mean Rank between the classic (47.10) and the modified (102.96) lateral methods is statistically significant (P < 0.001). CONCLUSIONS: The CMNA method is an excellent tool for studying the lateral distribution.We recommend using the modified lateral view as the preferred option for obtaining lateral hip radiographs after CMN surgery due to its superior distribution of CMNA and greater patient-friendliness.

Outcomes of Postoperative Overnight High-Acuity Care in Medium-Risk Patients Undergoing Elective and Unplanned Noncardiac Surgery.

Importance: Postoperative complications are increasing, risking patients' health and health care sustainability. High-acuity postoperative units may benefit outcomes, but existing data are very limited. Objective: To evaluate whether a new high-acuity postoperative unit, advanced recovery room care (ARRC), reduces complications and health care utilization compared with usual ward care (UC). Design, Setting, and Participants: In this observational cohort study, adults who were undergoing noncardiac surgery at a single-center tertiary adult hospital, anticipated to stay in hospital for 2 or more nights, were scheduled for postoperative ward care, and at medium risk (defined as predicted 30-day mortality of 0.7% to 5% by the National Safety Quality Improvement Program risk calculator) were included. Allocation to ARRC was based on bed availability. From 2405 patients assessed for eligibility with National Safety Quality Improvement Program risk scoring, 452 went to ARRC and 419 to UC, with 8 lost to 30-day follow-up. Propensity scoring identified 696 patients with matched pairs. Patients were treated between March and November 2021, and data were analyzed from January to September 2022. Interventions: ARRC is an extended postanesthesia care unit (PACU), staffed by anesthesiologists and nurses (1 nurse to 2 patients) collaboratively with surgeons, with capacity for invasive monitoring and vasoactive infusions. ARRC patients were treated until the morning after surgery, then transferred to surgical wards. UC patients were transferred to surgical wards after usual PACU care. Main Outcome and Measures: The primary end point was days at home at 30 days. Secondary end points were health facility utilization, medical emergency response (MER)-level complications, and mortality. Analyses compared groups before and after propensity scoring matching. Results: Of 854 included patients, 457 (53.5%) were male, and the mean (SD) age was 70.0 (14.4) years. Days at home at 30 days was greater with ARRC compared with UC (mean [SD] time, 17 [11] vs 15 [11] days; P = .04). During the first 24 hours, more patients were identified with MER-level complications in ARRC (43 [12.4%] vs 13 [3.7%]; P < .001), but after return to the ward, these were less frequent from days 2 to 9 (9 [2.6%] vs 22 [6.3%]; P = .03). Length of hospital stay, hospital readmissions, emergency department visits, and mortality were similar. Conclusions and Relevance: For medium-risk patients, brief high-acuity care with ARRC allowed enhanced detection and management of early MER-level complications, which was followed by a decreased incidence of subsequent MER-level complications after discharge to the ward and by increased days at home at 30 days.

Profile of the Postoperative Care Provided for Patients With Pancreatic and Periampullary Cancers by Family and Unpaid Caregivers.

PURPOSE: Patients with pancreatic and periampullary cancers may experience significant reduction in their quality of life and often rely on family and unpaid caregivers for assistance after surgery. However, as caregivers are not systematically identified, little is known about the nature, difficulty, and personal demands of assistance they provide. We aim to assess the frequency and difficulty of specific assistance caregivers provide and identify potential interventions that could alleviate the caregiving demands. METHODS: This was a prospective, multi-institutional study of caregivers accompanying patients with periampullary and pancreatic cancer at their 1-month postpancreatectomy office visit. An instrument that drew heavily on the National Study of Caregiving was administered to caregivers. RESULTS: Of 240 caregivers, more than half (58.3%) of caregivers were the patients' spouse, a quarter (25.8%) were daughters or sons, 12.9% other relatives, and 2.9% nonrelatives. Caregivers least frequently provided assistance with transportation (14.6% every day) and most frequently provided assistance with housework (65.0% every day, P = .003) and diet (56.5% every day, P = .004). Caregivers reported the least difficulty helping patients with exercise (1.5% somewhat difficult). Caregivers reported significantly more difficulty with assisting with housework (14.5% somewhat difficult, P < .001) and diet (14.9% somewhat difficult, P < .001). Caregivers identified the immediate postpancreatectomy and early discharge periods as the most stressful phases. They also reported having received very little information about available services that could have supported their efforts. CONCLUSION: Caregivers of patients with periampullary or pancreatic cancer provide considerable assistance in the postoperative period and many reported difficulty in assisting with housework and diet. Work is needed to better prepare and support caregivers to better enable them to adequately care for patients with pancreas and periampullary cancer.

Partner Involvement Reduces Postoperative Care Burden Following Penile Prosthesis Placement.

OBJECTIVE: To determine whether preoperative partner involvement at clinic appointments is associated with deviation from a standardized postoperative care pathway for patients undergoing an inflatable penile prosthesis placement. METHODS: This is a retrospective study of 170 patients undergoing primary inflatable penile prosthesis placement performed by a single surgeon between 2017 and 2020. A standardized postoperative clinical pathway was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine whether partner involvement was associated with unanticipated follow-up visits. RESULTS: Partners were involved in preoperative visits for 92 patients (54%). Additional unplanned follow-up visits were observed for 58 patients (34%) between 0 and 6 weeks and for 28 patients (16%) after 6 weeks from surgery. Partner involvement was associated with reduced odds of unanticipated follow-up visits, both between 0 and 6 weeks (odds ratios 0.37, 95% CI 0.18-0.75) and after 6 weeks (odds ratios 0.33, 95% CI 0.13-0.81) in adjusted models. CONCLUSION: Having a patient's partner involved during the preoperative period is associated with a significant reduction in unanticipated follow-up. We would recommend that urologists routinely encourage patients considering the insertion of a penile prosthesis to involve their partners in perioperative visits. Further research needed is needed to determine how to best support patients during surgical decision-making and through the postoperative period.

Postoperative Rehabilitation Following Rotator Cuff Repair.

Postoperative rehabilitation following rotator cuff repair is essential for a positive patient outcome. Each patient should have a program tailored to their individual tear and repair characteristics. Their plan should be advanced according to their progress, with therapist and surgeon communication. The rehabilitation progresses through 4 stages. This begins with a period of immobilization, passive range of motion, and protecting the repair and ends with functional and sport-specific exercises. Rehabilitation advances in progress-based steps during 24 weeks. The rehabilitation process aims to balance healing of the tendon repair and the risk of postoperative stiffness.

Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis.

An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.

Comparison of the Outcomes of Flexor Tendon Repair in Zone II Using the Original and Adjusted Strickland Scores and the 400-Points Hand Test.

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests - the original and adjusted Strickland scores - and a global hand function test, the 400-points test. Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19-82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists. Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test. Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score. Level of Evidence: Level IV (Therapeutic).