Three recent studies published over the past four months involving nearly 200 patients in total provide additional evidence of the positive outcomes of transoral fundoplication (TIF) for the treatment of gastroesophageal reflux disease (GERD). The studies demonstrated a high therapeutic response rate with patients getting off daily proton pump inhibitors, significant response to objective reflux measurements, and a low complication rate of around 2%. The largest study to date involving 124 patients showed 75-80% of patients had normalized symptom scores and 97% were off daily PPI medications post-TIF. The growing body of clinical evidence supports TIF as a safe and effective alternative to traditional anti-reflux surgeries for appropriately selected GERD patients.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
Background: The transition from resident physician to independent practitioner is an important period for young physicians.Optimally, they would feel well prepared to independently care for all patients presenting to them for anesthesia, however, this is unlikely Methods: A survey was emailed to all accredited anesthesiology residency program coordinators in April 2018 for further distribution to their CA3 residents. The survey collected data on the resident’s perception of his or her preparedness to manage a variety of anesthesia cases, patients with comorbid conditions, and ethical issues as well as perform various procedures.
This presentation was delivered to the WMRC in March 2017.
The first paper was published in BJS in Dec 2019. The data was collected from March 2017. The planning began in 2015.
https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11440
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
Our Experience with Pre-Operative Haemostatic Assessment of Paediatric Patien...Dr Gav Terna
: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, preoperative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. But because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in Paediatric patients undergoing adenoidectomy, tonsillectomy or both in our Centre
This presentation was delivered to the WMRC in March 2017.
The first paper was published in BJS in Dec 2019. The data was collected from March 2017. The planning began in 2015.
https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11440
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
Our Experience with Pre-Operative Haemostatic Assessment of Paediatric Patien...Dr Gav Terna
: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, preoperative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. But because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in Paediatric patients undergoing adenoidectomy, tonsillectomy or both in our Centre
Contents lists available at ScienceDirectApplied Nursing RAlleneMcclendon878
Contents lists available at ScienceDirect
Applied Nursing Research
journal homepage: www.elsevier.com/locate/apnr
Original article
Optimize patient outcomes among females undergoing gynecological
surgery: A randomized controlled trial
Kari Johnson (PhD, RN, ACNS-BC, Hartford Scholar)⁎, Sherry Razo (M.A.-L., BSN, RN, NEA-BC),
Jeannie Smith (BSN, CMSRN), Alex Cain (RN), Kathi Soper (BSN, RN-BC)
Honor Health Thompson Peak Medical Center, 7400 E. Thompson Peak Parkway, Scottsdale, AZ 85255, United States
A R T I C L E I N F O
Keywords:
Gynecological surgery
Enhanced Recovery After Surgery (ERAS)
Hysterectomy
Bundle components
Institute of Healthcare Improvement
Length of stay
30 day readmission
Patient satisfaction
Randomized controlled trial
A B S T R A C T
Background: Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after
Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery.
Purpose: Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day
readmission, and patient satisfaction among patients undergoing gynecologic surgery.
Design: Prospective, comparative, randomized design
Setting: 28 bed Medical Surgical Unit
Sample/Intervention: 50 patients undergoing hysterectomy, 25 who received post-operative evidence based
bundle/standard education, and 25 who received standard education packet. Bundle components included 1)
early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up
phone call was made in two to three days following discharge for both groups utilizing teach-back.
Results: 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day read-
missions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the
indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group
and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle
group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group
felt that overall nursing care received was very good to excellent.
Conclusion: Optimizing peri-operative education using a bundle approach to provide evidence based interven-
tions can minimize risk and enhance early recovery for females undergoing gynecological surgery.
1. Introduction
A hysterectomy is a common gynecological surgical procedure with
minimally invasive methods including vaginal or laparoscopic proce-
dures. Studies have shown that preoperative patient education can
improve patient outcomes after surgery, including reduced length of
hospital stay, decreased post-operative complications, and increased
patient satisfaction with the surgical experience (Modesitt et al., 2016;
Steiner & Strand, 2017; Wijk, Franzen, Ljungqvist, & Nilsson, 2014).
Enhanced recovery p ...
Outpatient surgery benefits patients and surgeons alike, as it is convenient, safe and cost-effective. We sought to assess the safety and feasibility of daycare thyroid surgery in a stand-alone Daycare Surgery Center in South India.
KinexCONNECT improves patient experience and therapy compliance during recovery from total knee replacement Focus groups conducted by Kinex Medical Company and HealthFactors. Authored by: Mike Buckholdt, BA, MPT, and Ram Rajagopalan, MS, MBA
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
ColonoscopyWendy Serrano, SN BSNImportance of a colonosc.docxmccormicknadine86
Colonoscopy
Wendy Serrano, SN BSN
Importance of a colonoscopy
To visualize the lining of the colon and rectum in order to:
Help detect colon and rectal cancer
Help locate low GI bleeding
Evaluate for recurrence of polyps or lesions
Evaluate abnormal results for tests other than colonoscopies
Investigate rectal bleeding and abdominal pain
Colonoscopy. (2018, May 22). Retrieved from https://www.mayoclinic.org/tests- procedures/colonoscopy/about/pac-20393569.
Normal and Abnormal results
Normal results are light pink mucosa with folds and pits.
Abnormal results:
Hemorrhoids- vein clumps near the rectum
Polyps- growths of tissue in the mucosal lining
Inflammation and ulcers- can result from NSAID’s, inflammatory bowel diseases, and cancers.
Bleeding- can come from tumors and ulcers.
Can also see foreign bodies or fistulas if present
Shmerling, R. H. (2018, April). Understanding the results of your colonoscopy. Retrieved from https://www.health.harvard.edu/staying-healthy/understanding-the-results-of-your- colonoscopy.
What may affect results?
Decreased or no visualization due to:
Soapsuds because they irritate the lining and cause an increase in mucus
Barium from previous diagnostic tests
Not cleaning the intestines correctly
Some previous surgeries, radiation or chronic inflammatory diseases may not allow the colonoscope to be inserted.
Chernecky, C. C. (2013). Laboratory tests and diagnostic procedures. Missouri: Elsevier. Page 358
Patient care and teaching
Prep: typically there is a clear liquid diet requirement the day before, no red liquids. Then the patient is typically NPO after midnight. Laxatives or enemas may be required as well.
During: A sedative is typical. The doctor will position the patient in a side lying position with their legs to their chest. The tube that will be inserted has a light and a camera on the end of it. The camera will allow the doctor to see the images on an external monitor like a computer screen. They may also take pictures of abnormalities. The doctor can also insert instruments to take samples or remove polyps. The procedure is about 30-60 minutes long.
Post: The sedative effects will take all day to completely wear off so the patient will need a driver to drive them home. The nurse will take vitals every 15-30 minutes until the patient is fully recovered. A special diet may be required for certain procedures, such as when removing polyps. If not they may resume normal diet. The patient may have gas or bloat that can be resolved by walking. A small amount of blood is not worrisome but blood clots, a large amount of blood, pain and a fever are.
Colonoscopy. (2018, May 22). Retrieved from https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569.
Chernecky, C. C. (2013). Laboratory tests and diagnostic procedures. Missouri: Elsevier.
Nursing diagnosis
Acute pain related to GI tissue irritation as evidenced by reports of chronic abdominal pain that does no ...
Recruitment Metrics from TogetherRA: A Study in Rheumatoid Arthritis Patients...John Reites
DIA poster presentation on May, 30, 2013 for a direct-to-patient RA patient study that collected ePRO, medical chart data and a biologic lab sample from 23andMe with integration for final analysis.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Flyer for one day seminar for surgeons and gastroenterologists showcasing innovative technologies in endosurgery and robotic surgery
Sept 19, 2011 New Delhi
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. 3390900-114300For more info call 0800 0988 435 (UK)00For more info call 0800 0988 435 (UK)<br />ENDOGASTRIC SOLUTIONS ANNOUNCES SIGNIFICANT EXPANSION OF U.S. DATA SUPPORTING TRANSORAL FUNDOPLICATION<br />Three Recently Published Studies Demonstrate Positive Outcomes for Nearly 200 Patients<br /> <br />Redwood City, CA (February 17, 2011) – HYPERLINK quot;
https://webmail.chpnet.org/owa/redir.aspx?C=af99dea77d854e659eebdd61d07b9cd1&URL=http%3a%2f%2fwww.endogastricsolutions.com%2fquot;
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EndoGastric Solutions (EGS),the recognized leader in the emerging field of Natural Orifice Surgery (NOS), announced that three clinical studies on transoral fundoplication have been published over the past four months. The addition of over 185 patients to the literature substantially increases the evidence supporting the safety and effectiveness of the Transoral Incisionless Fundoplication (TIF) procedure for the surgical treatment of gastroesophageal reflux disease (GERD).<br />Taken together, these publications demonstrate:<br />Excellent therapeutic response rate in patients with both typical and atypical symptoms of GERD (79-97% off daily PPI medications)<br />Significant response to objective measurements of reflux (89% normalization of reflux episodes)<br />Low complications rate (aggregate 2%)<br />No adverse effects of dysphagia and bloating common to laparoscopic fundoplication surgery<br />The most recent study, by William Barnes, MD (Livingston Hospital and Healthcare Services, Inc., Salem, KY) and Kevin Hoddinott, MD (Munroe Regional Medical Center, Ocala, FL), was published February 8th in the online edition of Surgical Innovation and is being published in the print edition. This study is the largest TIF study published to date and includes 124 patients treated with TIF (110 followed for a median 7 months). Results showed that:<br />75-80% of patients recorded normalized symptom scores for both typical and atypical symptoms of reflux<br />97% of patients were off daily PPI medications<br />83% of patients were satisfied with their health condition post-TIF, compared to 3% before their procedure.<br />Drs. Barnes and Hoddinott commented, quot;
Less than 10% of our patients had persistent heartburn requiring medical therapy. This level compares favorably to 32% reported in a community-based study with laparoscopic Nissen.quot;
They added, quot;
The absence of complications and low reoperation rate of 4% were below the published values for laparoscopic fundoplication.quot;
<br />quot;
These new clinical findings establish that TIF can produce excellent and reproducible outcomes in a broad spectrum of surgical practice scenarios, including large academic centers and both large and small community hospitals,” commented Thierry Thaure, President and Chief Executive Officer of EndoGastric Solutions. quot;
This most recent study represents the largest transoral fundoplication patient series to date and shows that TIF can be safe and provide exceptional results both during the surgeon’s learning curve and after they have mastered the technique. This data is very encouraging.quot;
Surgical Endoscopy published in its December 2010 edition an article by Reginald Bell, MD (Swedish Medical Center and SurgOne PC, Englewood, CO), with a 6-month median follow-up of 37 TIF patients. The study demonstrated significantly improved symptomatic and objective outcomes in over 70% of patients.<br />Significant improvement was seen in both typical (heartburn and regurgitation) and atypical (extraesophageal symptoms) of reflux in 64% and 70-80% of patients, respectively.<br />82% of patients remained off their reflux medications.<br />Average number of reflux episodes over a 24-hour period was normalized in 89% of patients. Acid exposure was significantly improved and normalized in 61% of patients.<br />quot;
Our results are significant in terms of symptom improvement and objective reflux control,” commented Dr. Bell. quot;
Perhaps just as important, we have not observed any of the side effects seen with traditional fundoplications. Transoral esophagogastric fundoplication has a role in the treatment of GERD,” he concluded.<br />In October 2010, a 26-patient study was published in Surgery by Vic Velanovich, MD (Henry Ford Hospital, Detroit, MI). The study found that 79% of patients 6-8 weeks after their TIF procedure were off their reflux medications and were satisfied with their symptom relief.<br />quot;
The body of clinical evidence supporting both the safety and the efficacy of TIF is growing,” said Mr. Thaure. quot;
These three new published studies build upon our growing foundation of clinical data and continue to validate that TIF is rapidly becoming the standard of care for appropriately selected patients that are candidates for surgical fundoplication.quot;
<br />About TIF<br />The TIF surgical procedure corrects the root cause of GERD, an anatomic defect at the gastroesophageal junction. Performed through the mouth, rather than abdominal incisions, the procedure constructs an esophagogastric fundoplication and reestablishes a barrier to reflux.<br /> <br />