reviewed the literature ;Multidisciplinary management of gastric cancer
Yixing Jianga and Jaffer A. Ajani
; pictures taken from Sabiston textbook of surgery.
brief description of renal/ urinary system surgery
including: pyelolithotomy, nephrectomy, nephron-sparing surgery, Ureterotomy, Cystotomy, Nephrolithotomy
including surgical requirement for renal system surgery
reviewed the literature ;Multidisciplinary management of gastric cancer
Yixing Jianga and Jaffer A. Ajani
; pictures taken from Sabiston textbook of surgery.
brief description of renal/ urinary system surgery
including: pyelolithotomy, nephrectomy, nephron-sparing surgery, Ureterotomy, Cystotomy, Nephrolithotomy
including surgical requirement for renal system surgery
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)Dr Harsh Shah
Mesopancreas is a complex anatomical entity which possesses critical importance in oncosurgery. Certain other aspects of pancreatic anatomy also dealt with.
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)Dr Harsh Shah
Mesopancreas is a complex anatomical entity which possesses critical importance in oncosurgery. Certain other aspects of pancreatic anatomy also dealt with.
This presentation was delivered at Puri on 10th january 2015
on the occasion of annual Rotary District Conference along with IMA Puri. It highlights on metabolic syndrome and its surgical solution.
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
The Mystery of Bile or No Bile: “Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
2. • Western world is more affected
• One third of the U.S. adult population is obese
• 300000 annual deaths
• second leading cause of preventable death
• morbidly obese man has a 22% reduction in life expectancy,
3. DEFINITION
• BMI equal to or greater than 40 kg/m2 without comorbidities
and >35kg/m2 with comorbidities .
National Institutes of Health. Am J Clin Nutr. 1992
4. HISTORY
• Jejunoileal bypass (JIB), was described in 1954
• Edward Mason devised the vertical banded Gastroplasty in 1960’s
• Nicola Scopinaro biliopancreatic diversion (BPD)
• Marceau duodenal switch non dividing duodenem 1993
• Hess and hess modified it to dividing the duodenum in 1998
• Gagner in 2000 laproscopic bpd-ds
• Fisher text book of surgery 6th edition .
7. PATHOPHYSIOLOGY
• Grehlin hormone at fundus – appetite stimulus
• GLP-1, PYY and CCk causes insulin release – reduces apetite
• Trifty genes
• Prentice AM, Natural selection of thrifty genes , Int J Obes (Lond) 2008
8. RATIONALE FOR SURGERY
• Increase life expectancy
• Decrease comorbidities
• Decrease health-care costs to society
• Swedish Obese Subjects study, which started in 1987
9. SELECTION CRITERIA
• International Federation for Surgery of Obesity and the National Institute for Clinical Excellence.
• Body mass index (BMI) >40 kg/m2 or BMI 35–39 kg/m2 with comorbid disease
• Minimum of 5 years obesity
• Failure of conservative treatment
• No alcoholism or major untreated psychiatric illness
• Avoid if likely to get pregnant within 2 years
• Age limits 18–55 (relative)
• Acceptable operative risk on preoperative assessment
11. PLANNING
• No bariatric operation will produce optimal long-term results without
significant changes in diet, exercise,and lifestyle.
• Low carbohydrate diet for atleast 2 weeks .
• “I will never go back to being the way I was before.”
12. PER-OPERATIVE ASSESSMENT
• Before the clinical visit
• medically supervised diet
• Initial Clinic Visit
• Group presentation on preoperative and postoperative nutritional issues by the nutritionist
• Individual assessment by the surgeon’s team
• Individual counseling session with the surgeon
• Individual counseling session with the nutritionist
• Screening blood tests
13. • Subsequent Events and Evaluations
• Screening flexible upper endoscopy
• Screening ultrasound of the gallbladder
• Subsequent Clinic Visits
• Counseling session with the surgeon (including selection of the date for surgery)
• Education session with the nurse educator
• Preoperative evaluation by the anesthesiologist
• Final paperwork by the preadmissions center
14. SPECIAL EQUIPMENT
• Hydraulically operated table accommodating up to 800 lb.
• Side attachments
• Foam cushioning
• Extra large SCD stockings
• Wide and secure padded straps for
the abdomen and legs
15. • High-flow insufflators
• Extra-long staplers
• Atraumatic graspers
• Extra-long trocars
• An ultrasonic scalpel
• A fixed retractor device for clamping and holding the liver retractor is also essential.
19. VERTICAL BAND GASTROPLASTY
• Abandoned
• Poor long-term weight loss
• High rate of late stenosis of the gastric outlet
• Regain of weight
20. LAPROSCOPIC ADJUSTIBLE GASTRIC
BANDING
• FDA approved LAP-BAND and REALIZE BAND
• Principle : Augment the early satiety, Vagal nerves feedback mechanism
• Advantage : Adjustability and Low morbidity and mortality .
• Ideal method for patients with BMI 35 - 40kg/m²
• 0.1% perioperative mortality rate
21. • 15mm pneumoperitoneum left upper quadrant, at the midclavicular line, one hand breath
below the xiphoid.
• 12-mm camera port in the midline approximately 15 cm from the xiphoid.
• 5-mm port is placed in the right upper quadrant for the surgeon’s left hand.
• 5-mm port in the left upper quadrant is placed for the assistant
• Port in the epigastrium is placed to assist in retracting the left lobe of the liver
22.
23.
24. SLEEVE GASTRECTOMY
• 0.2 per cent operative mortality.
• Removes most of the grehlin
• Disadvantage : leakage, sleeve expansion
• 65 per cent weight loss by 2 years
• 10-20% resleeve procedure
25.
26.
27. ROUX-EN-Y GASTRIC BYPASS
• 65–75 per cent excess weight loss
• Risk 0.5 per cent
• Uses : GERD or type 2 diabetes.
• Limitation : Decreases Iron absorption .
• Theories : Foregut and Hind gut theory
proposed for weight loss
28.
29. BILIOPANCREATIC DIVERSION – WITH OR
WITHOUT
A DUODENAL SWITCH
• 75–85 per cent excess
• Mortality of 1–2 per cent
• Extreme malabsorption
31. RESULTS
• How to define success?
• Losing at least 50 per cent of the excess weight in the first 12–24 months.
• Decrease comorbidities
• Improved quality of life .
