- The study assessed the first experience with outpatient total hip arthroplasty (THA) in a public hospital in Chile.
- Of 138 eligible patients, 72 hips in 69 patients underwent outpatient THA. 94.4% (68/72) were discharged the same day.
- There were no major complications within the first week. Two patients had single dislocation episodes requiring one stem revision. One patient had deep vein thrombosis.
Non-operative Treatment Compared to Surgery in the Management of Uncomplicate...asclepiuspdfs
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the “alternation” method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed.
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
Non-operative Treatment Compared to Surgery in the Management of Uncomplicate...asclepiuspdfs
Purposes: We are aiming to investigate the safety and efficacy of the non-operative treatment (NOT) for the management of acute appendicitis (AA), to avoid the risk of unnecessary surgery. Methods: The study includes 400 consecutive patients who were diagnosed as AA. The study involved patients with symptoms <72 h and the first attack of AA. Patients divided into two equal groups using the “alternation” method. In the first group, patients were hospitalized and received medical treatment, while in the second group, appendectomy was done. After discharge, follow-up was done in all cases for 2 years. Data collected and statistically analyzed.
journal club and critical appraisal checklist
intensive recruitment versus moderate recruitment strategy in postop cardiac surgery patients to avaoid postop pulmonary complications
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Day care surgery was started as money saving modality. It has picked up momentum even in India. In last one decade due to innovations in surgical techniques and advances in anaesthesia, the positive feedback from the patients and their relations has enhanced the popularity of day care surgery. There is an immense opportunity for expansion of day care surgery in India to ensure faster, safer, cost-effective and patient turnover. Retrospective and Prospective day care surgery is being performed on general surgery patients at National Institute of Medical Science and Hospital (NIMS), Jaipur from 2014 to 2017. During this period, 4547 day care surgical procedures and 2757 OPD procedures were performed. Only 212 day care surgery patients (2.9%) were transferred to day care unit as in-patient admission. We found the day care surgery as safe and effective means of fast track surgery, which was economical also. In-patient admission following day surgery can be reduced by improved out-patient selection of cases by introducing a pre-admission assessment form filled in at the out-patient clinic, operating early on day care by using separate day care theatre. Anaesthetic complications were reduced by increased use of local anaesthetic techniques.
Key-words: Day care surgery, Ambulatory surgery, Anaesthesia, Early Ambulation, Post-Operative, Laparoscopy
Effectiveness of Passive Range of Motion Exercises on Hemodynamic parameters ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
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.
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
Crimson Publishers-Herring Bone Stitch: Knitting to Secure Abdominal Wall Clo...CrimsonGastroenterology
Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy by Dhananjaya Sharma in Gastroenterology Medicine & Research: Laparotomy
Introduction: 5-26% of patients develop incisional hernia (IH) after midline laparotomy. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.
Methods: This prospective observational study was done from March 2015 to December 2017 in a teaching hospital in Central India. Consecutive patients undergoing emergency midline laparotomy were included. Study group (patients undergoing single layer continuous herring bone closure of rectus sheath with Polypropylene no. 1 suture) was compared with control group (patients undergoing standard single layer continuous closure of rectus sheath with Polypropylene no. 1 suture). Patients were followed up till 1 year. Outcomes noted were surgical site infection (SSI), proline knot granuloma or sinus formation, superficial wound dehiscence, fascial dehiscence and IH.
Results: There were 112 patients in study group and 108 in control group with comparable demographics.Vector physics of Herring bone stitch showed that any tension on the suture line is preferentially distributed parallel to the wound. Incidence of SSI, proline knot granuloma and superficial wound dehiscence was comparable among the two groups. The incidence of fascial dehiscence (0.045) and IH was less (p = 0.009) in study group.
Discussion: The Herring bone stitch is technically easy, reproducible, safe and can be performed quickly. The present study shows superiority of ‘herring bone suture’ over conventional closure of rectus sheath in emergency midline laparotomy.
Day care surgery was started as money saving modality. It has picked up momentum even in India. In last one decade due to innovations in surgical techniques and advances in anaesthesia, the positive feedback from the patients and their relations has enhanced the popularity of day care surgery. There is an immense opportunity for expansion of day care surgery in India to ensure faster, safer, cost-effective and patient turnover. Retrospective and Prospective day care surgery is being performed on general surgery patients at National Institute of Medical Science and Hospital (NIMS), Jaipur from 2014 to 2017. During this period, 4547 day care surgical procedures and 2757 OPD procedures were performed. Only 212 day care surgery patients (2.9%) were transferred to day care unit as in-patient admission. We found the day care surgery as safe and effective means of fast track surgery, which was economical also. In-patient admission following day surgery can be reduced by improved out-patient selection of cases by introducing a pre-admission assessment form filled in at the out-patient clinic, operating early on day care by using separate day care theatre. Anaesthetic complications were reduced by increased use of local anaesthetic techniques.
Key-words: Day care surgery, Ambulatory surgery, Anaesthesia, Early Ambulation, Post-Operative, Laparoscopy
Effectiveness of Passive Range of Motion Exercises on Hemodynamic parameters ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
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.
EARLY ENTERAL FEEDING IN CASES OF GASTROINTESTINAL ANASTOMOSISAishwaryaMohanraj1
Bowel anastomosis and perforation suturing are commonly performed procedures by general surgeons worldwide both as emergency and elective procedures(1).
The traditional practice after major gastrointestinal surgeries is to keep the patient nil by mouth to prevent postoperative nausea and vomiting and protect the anastomotic site till return of bowel function.
Recently emphasis has been given to initiating early enteral feeding within 6 to 24 hours in the postoperative period.
Early enteral feeding is believed to reduce stress response, improve immunological response and promotes wound healing while significantly reducing septic complications after major abdominal procedures(2) chiefly due to enterocyte growth stimulation which results in an improved mucosal barrier function and decreased bacterial translocation 3.
Special Surgical Technique For Knee ArthroplastyApollo Hospitals
Seriously owing to the intense scarcity of trial studies, clin-
ical research & literature, evidence based clinical guidelines
are not available to guide physiotherapy rehabilitation post
total knee arthroplasty. In order to propagate evidence
based practice guidelines & uniformity in patient’s care,
well-designed clinical trials are required to identify cost
a
effective rehabilitation programmes after total knee
arthroplasty.1
Less invasive surgery, especially total knee arthroplasty
is of interest to both surgeons & patients, with the primary
goal of improving early recovery parameters. Patients are
attracted more towards minimal invasive surgery with the
concept of less trauma, better cosmetic appearance &
results.
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after ab...Takehiko Ito
G112 Ito & Shiromaru (2009). Patients’ coping strategies before and after abdominal surgery: A questionnaire survey. The 1st International Nursing Research Conference of World Academy of Nursing Science, Kobe: Program & Abstracts, 235.
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 ...
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Successful initial experience with a novel outpatient total hip
1. ORIGINAL PAPER
Successful initial experience with a novel outpatient total hip
arthroplasty program in a public health system in Chile
Orlando Paredes1,2
& Rodrigo Ñuñez3,4
& Ianiv Klaber1,5
Received: 19 December 2017 /Accepted: 27 February 2018
# SICOT aisbl 2018
Abstract
Purpose The aim of the present study was to assess the first experience with outpatient total hip arthroplasty (THA) in a public
health environment in Chile.
Methods Prospective series of the first 69 patients/72 hips. Surgery was performed in a public university-affiliated hospital. The
patients were 64 (31–84) years old and healthy (ASA I–II) candidates for a primary hip arthroplasty.
Results The outpatient track had 52.2% of arthroplasty candidates included and 94.4% (68/72 hips) were successfully discharged
the same day. There were no emergency room visits during the first week after surgery. Two patients had single dislocation
episodes, one requiring stem revision. There was one deep vein thrombosis. There were no other complications. All the patients
reported to be satisfied with the outpatient track.
Interpretation An outpatient track can be developed in a safe manner in this healthcare setting and population. This track of care
was well accepted by the patients.
Keywords Total hip arthroplasty . Length of stay . Outpatient surgery . Osteoarthritis
Introduction
Total hip arthroplasty (THA) has usually been considered
an inpatient procedure. During the last years, better
anesthesia/analgesia techniques and early mobilization
permitted shortening the length of stay (LOS) after THA
from 14–21 days in 1975 to four to five days [1–3]. Aging
and more frequent indication of THA create a tremendous
demand on health services. This demand not only affects
waiting times, but also impacts hospital bed and operating
room (OR) usage. In the last ten years, some authors have
published their experience in fast track surgery for THA,
accomplishing equivalent patient care with LOS of up to
two days, some reporting less complications and higher
patient satisfaction [4–6].
Shorter LOS reduces total costs and waiting time from
procedure indication to surgery, both of which have cre-
ated a trend towards this modality of care [5, 7, 8]. Scant
reports describe the characteristics and results for outpa-
tient THA, reporting safe outpatient programs [9, 10].
Two similar recent reports analyzing big databases of total
joint replacements (TJRs) show outpatient programs as
safe as inpatient and even with less complications.
Between 2011 and 2014, 0.7% of TJRs were performed
as an outpatient in the USA [11].
In 2014, a pilot program for outpatient TJR was designed
and implemented in our hospital. This design followed the
path signaled by successful European experiences with some
adaptations to local context.
The aim of the present study was to assess the first experi-
ence with outpatient THAs in Hispanic and Spanish-speaking
population and report complications and patient satisfaction.
Our hypothesis states that with outpatient THA modality
there will be no increase in major complications.
* Ianiv Klaber
iklaber@med.puc.cl
1
Orthopedic Surgery, Hospital Clinico Metropolitano de La Florida,
Santiago, Chile
2
MEDS Clinical Sport Center, Santiago, Chile
3
Service of Physical Therapy, Hospital Clínico La Florida,
Santiago, Chile
4
Department of Physical Therapy, Faculty of Medicine, University of
Chile, Santiago, Chile
5
Department of Orthopedic Surgery, Pontificia Universidad Catolica
de Chile, Diagonal Paraguay 362, Tercer Piso,
8330077 Santiago, Chile
International Orthopaedics
https://doi.org/10.1007/s00264-018-3870-6
2. Patients and methods
This study was carried at a public university-affiliated hospi-
tal. It was approved by the Institutional Review Board and
informed consent was waived for all patients before being
included in the outpatient track.
Between December 2014 and August 2016, 138 patients
waiting for a primary total hip arthroplasty were assessed for
inclusion in the outpatient arthroplasty program. During a visit
to the clinic, patients who were thought to be suitable for the
outpatient management modality were told about the program
and asked for their agreement. First inclusion criteria was to
feel comfortable with outpatient modality management.
Patients were appointed for an interview with the
outpatient program nurse and a physical therapist visited
every patient's home. During the interviews and home
visit appropriateness for the program was assessed, pa-
tients were trained for using walking aids and the
inclusion-exclusion criteria were reviewed in situ.
Patients and family were instructed after surgery care,
and questions and fears were addressed.
Candidates were healthy patients (ASA I–II), with primary
osteoarthritis and an adequate family support. Patients with
comorbidities requiring close observation (anticoagulation or
insulin users) were excluded. The patient’s flow diagram is in
Fig. 1 and the inclusion/exclusion criteria are detailed in
Table 1.
All surgeries were performed through an anterolateral
or direct lateral approach. Regional anesthesia was pre-
ferred and multimodal opioid-sparing analgesia was
used. Local infiltration of anaesthetics (LIA) with
chirocaine was used as a standard. One gram of
tranexamic acid was administered before incision. No
drains were used.
Before and during surgery, nausea was prophylactically
and actively managed with dexamethasone 4–8 mg and
ondansetron 4–8 mg.
Starting time, surgery duration and post-operative hospital
stay were registered.
After surgery, patients were transferred to the Post
Anesthesia Care Unit (PACU) where multimodal opioid-
sparing analgesia and aggressive fluid load (IVand oral) were
continued. Post-op x-rays and haematocrit/haemoglobin were
tested before discharge. Patients did not receive physical ther-
apy (PT) before discharge.
Post-operative analgesia consisted of acetaminophen 1 g
IV, ketorolac 30 mg IV, and the short-acting opioid fentanyl
25–100 μg IV; finally before discharge, 75 mg IV diclofenac
was administered.
Discharge criteria were as follows: adequate pain control
(VAS ≤ 4), being able to eat and drink, absence of nausea,
orthostatic symptoms, and haemoglobin ≥ 7 mg/dL; resolu-
tion of motor blockage and dry wound draping were also
required.
Patients were transferred home in an ambulance with su-
pervision of the physical therapist, with instructions of bed
rest until visit by the nurse and physical therapist the next
morning.
During the first PT visit (the morning after the surgery),
patient and family were educated in dislocation
Assessed for elegibility (n=138)
Outpatient Track (n=72)
52.2% fulfilled inclusion criteria
and accepted the outpatient
Patients were able to go home
same day (n=68)
Follow-up 12 week (n=72)
The compliance rate was 100%
Stay overnight in the recovery room
(n=3)
Dropout (n=0)
Excluded (n=66)
Standard inpatient track
Transferred to the inpatient ward (n=1)
Fig. 1 Patient’s flow diagram
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3. precautions. Exercises started with quadriceps and gluteus
isometric contractions and active movements of the ankle,
as tolerated patients sat in the bed and stood. If no ortho-
static intolerance was evidenced, walking with full weight-
bearing assisted by a walker or two crutches was the final
goal of the first visit [12]. Further sessions included quad-
riceps and gluteus open chain exercises, stair training, and
walking in the street [13]. Home visits were scheduled
every 24 hours for a maximum of three days, and there
on every 48 hours afterwards for up to two to three weeks.
During the visit, in case of severe pain (VAS > 4) despite
acetaminophen plus tramadol, intramuscular diclofenac
75 mg was given. Weight-bearing as tolerated with a walk-
er or two crutches was indicated starting during the first PT
visit.
For venous thromboembolic prophylaxis, rivaroxaban
10 mg daily for 21 days after discharge was prescribed.
Follow-up was scheduled at discharge at two to four and
12 weeks post op. Every patient and responsible family mem-
ber received a mobile phone number for contact in case of
need.
Complications requiring nurse call, home visit, re-ad-
missions, or re-operations were documented (including
pain, dizziness, symptomatic anemia, nausea, deep vein
thrombosis or pulmonary embolism, wound problems,
bleeding, falls, dislocation, periprosthetic fracture, and
infection).
Level of satisfaction was evaluated with two questions:
1) If the patient would choose to perform the surgery again
as an outpatient
2) If he/she would recommend this track of care
Data normality was tested using with the Kolmogorov-
Smirnoff test. As results were not normal, median and range
are reported if not stated otherwise.
Results
During study period, 69 patients/72 hips were operated within
the outpatient track. The time lapse between first and second
outpatient hip replacement for those three cases of bilateral hip
arthritis was four months (3–5 months).
In the study time frame in which 72 hips were selected for
the outpatient track, other 66 hips were enrolled for the stan-
dard inpatient track representing a 52.2% of inclusion for the
outpatient track.
Patient’s characteristics are described in the Table 2.
Surgical time was 72 (+− 18) minutes. Patients remained in
the recovery room for five (3–22) hours after surgery.
There were no intra-operatory complications.
There were no transfusions in this group of patients.
Sixty-eight of the seventy-two (94.4%) cases were able to
go home the same day.
Three patients stayed overnight in the recovery room, two
because of nausea and one because the arranged transport to
home failed.
One patient stayed for four days. She was transfered to the
inpatient ward because of prologed anesthesia effects, referred
as persistent paresis and paresthesia.
There was no loss of follow-up and every patient complet-
ed the satisfaction survey.
Regarding outpatient PT, 90.3% of the patients were able to
stand and walk in the first visit and the rest (9.7%) in the
second PT visit. Reasons for not being able to walk were
orthostatic intolerance in four cases and pain in three.
The outpatient program nurse received nine phone calls
from nine patients, eight of them during the first two days after
discharge. The reasons for nurse calls were pain in seven cases
and nausea in two.
There were no emergency unit (EU) visits by any of the
studied patients during the first week after surgery.
One patient had a hip dislocation two weeks after surgery.
Subsidence of the femoral stem was noted and was revised to
a cemented stem with no further complications.
Table 2 Patient characteristics
Age (years) 64 (36–81)
Sex
Male 40
Female 32
BMI (kg/m2
) 28.3 (20.5–38.6)
ASA (%)
I 50
II 50
Primary osteoarthritis (%) 77.8
BMI, body mass index; ASA, American Society of Anesthesiologists
Table 1 Inclusion and exclusion criteria for the outpatient care track
Inclusion criteria Exclusion criteria
ASA I–II Insulin user
Simple primary THR Anticoagulated
Adequate family support Chronic renal failure (creatinine
clearance < 60 mL/min)
High dysplasia, post-traumatic osteoarthritis
Previous surgery with retained implants
Family care not available 24/7
Phone not available 24/7
Living in a second or higher floor with
no lift available
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4. One dislocation four weeks after surgery was reduced in
the EU, with the patient being discharged after two hours in
the recovery room, without further complications.
One case of symptomatic deep vein thrombosis was detect-
ed. There were no coronary events, infections, or any other
major medical complications in the cohort during the
three months of follow-up.
At six weeks, 72/72 reported to be satisfied with the
outpatient track and referred that they would choose this
track again and recommend being operated upon as an
outpatient. Three patients in this series had both hips
treated having decided to have the second joint operated
also as an outpatient. No patient asked for the inpatient
track for a second joint.
Discussion
Our study reports the first experience with outpatient
THA in the southern hemisphere, with Spanish-speaking
population. It has a relatively open inclusion criteria re-
garding age and starting time for the surgery. Considering
that particularities, the 94.4% of same-day discharge is
promising.
Many authors have published their progress implementing
fast track arthroplasty replacement programs, with heteroge-
neous levels of strictness for inclusion/exclusion criteria and
LOS ranging from two to five days [3].
Only a few reports about outpatient programs for THA are
available, limiting the data to a case series, and only one recent
randomized trial also reported similar outcomes comparing
with traditional inpatient tracks [10, 14, 15]. Some have lim-
ited the inclusion for the first case in the morning [16]. Even
more, some of those reports included patients delivered from
the hospital to an intermediate care facility, but still not
discharged to their homes.
Previous published data reports 75–88% success in same-
day discharge with different protocols, some more restrictive
than others, considering successful outpatient up to 23 hours
inside hospital facilities [10, 14, 15].
Our study has potential limitations; as this is the first report
of the outpatient program the sample size is small, there is no
control group to compare with inpatients and the follow-up
might be considered short. Patient satisfaction was evaluated,
but patient-reported outcomes might be included in the future
to enhance the quality of the register and also might identify
patients at risk for revision [17].
Our health system required to adapt some specific
parameters of the protocol (absence of physical therapy
in the hospital after surgery) which might reduce the
external validity of the results, although these particular-
ities might motivate other groups to adapt known proto-
cols to local realities.
The three month follow-up is a short period for arthroplasty
outcome evaluation, but it is the period in which more differ-
ences between this two care tracks may appear.
In our series, one patient unable to be discharged the same
day after the surgery had the procedure completed after
four pm, leaving no time for managing the symptoms and
performing the workup before the end of the journey. Most
of the outpatient protocols require the surgery to be scheduled
as the first or second surgery of the day. Because of local
administrative restrictions, many of our THA are being started
after four pm. Lack of safe mobilization has been reported to
be the main cause for failed same-day discharge. As our pro-
tocol starts physical therapy the first day after surgery (at
home), this was not considered a problem [18].
None of the complications/readmissions reported in our
cohort could have been prevented with a longer inpatient
care as none of them occurred during the first two to
three days after the surgery. This is in line with previous
reports, with no increase in complications with shorter
LOS [14, 15, 19]. There is one report of an increasing
incidence of hip dislocations with shorter LOS, but the
same has not been reproduced in more recent series
[20]. For patients with high risk of dislocation, dual mo-
bility cups might be considered in the future as high level
of satisfaction and low index of complications have been
reported recently [21, 22].
Despite the low incidence of complications and high index
of satisfaction reported by this cohort, complex cases may not
be suitable for outpatient care as they implicate longer proce-
dures, higher blood loss, and more complications (i.e., dys-
plastic and post-traumatic cases).
Age was not considered to be the exclusion criteria in this
pilot program, with a broad range of ages with a median of
64 years old (36–81). Older patients had a high degree of
satisfaction and did not present more complications.
Nevertheless, patients 70–81 years old are under represented,
which might explain our disparities with some published data
where patients older than 70 years old presented more com-
plications [11].
In summary, this relatively open protocol appears to be safe
and was well accepted by the patients. In this cohort undergo-
ing outpatient THA, 94.4% were able to go home the same
day of the surgery.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical approval This study was approved by the Institutional Review
Board.
Informed consent Informed consent was obtained from all individual
participants included in the study.
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5. References
1. Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM (1974) 2,
012 total hip arthroplasties. A study of postoperative course and
early complications. J Bone Joint Surg Am 56(2):273–284
2. Forrest GP, Roque JM, Dawodu ST (1999) Decreasing length of
stay after total joint arthroplasty: effect on referrals to rehabilitation
units. Arch Phys Med Rehabil 80(2):192–194
3. Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay
and patient satisfaction after hip and knee replacement surgery: fast-
track experience in 712 patients. Acta Orthop 79(2):168–173.
https://doi.org/10.1080/17453670710014941
4. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB,
Kehlet H (2011) Why still in hospital after fast-track hip and knee
arthroplasty? Acta Orthop 82(6):679–684. https://doi.org/10.3109/
17453674.2011.636682
5. Malviya A, Martin K, Harper I, Muller SD, Emmerson KP,
Partington PF, Reed MR (2011) Enhanced recovery program for
hip and knee replacement reduces death rate. Acta Orthop 82(5):
577–581. https://doi.org/10.3109/17453674.2011.618911
6. Raphael M, Jaeger M, van Vlymen J (2011) Easily adoptable total
joint arthroplasty program allows discharge home in two days. Can
J Anaesth 58(10):902–910. https://doi.org/10.1007/s12630-011-
9565-8
7. Aynardi M, Post Z, Ong A, Orozco F, Sukin DC (2014) Outpatient
surgery as a means of cost reduction in total hip arthroplasty: a case-
control study. HSS J 10(3):252–255. https://doi.org/10.1007/
s11420-014-9401-0
8. Bertin KC (2005) Minimally invasive outpatient total hip
arthroplasty: a financial analysis. Clin Orthop Relat Res 435:154–
163
9. Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ,
Hartzband MA, Lieberman JR, Mears DC (2003) Minimally inva-
sive total hip arthroplasty. Development, early results, and a critical
analysis. Presented at the Annual Meeting of the American
Orthopaedic Association, Charleston, South Carolina, USA,
June 14, 2003. J Bone Joint Surg Am 85-A(11):2235–2246
10. Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT (2010)
Outpatient total hip arthroplasty. J Arthroplast 25(4):501–506.
https://doi.org/10.1016/j.arth.2009.06.005
11. Courtney PM, Boniello AJ, Berger RA (2016) Complications fol-
lowing outpatient total joint arthroplasty: an analysis of a national
database. J Arthroplast. https://doi.org/10.1016/j.arth.2016.11.055
12. Jans O, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H
(2012) Orthostatic intolerance during early mobilization after fast-
track hip arthroplasty. Br J Anaesth 108(3):436–443. https://doi.
org/10.1093/bja/aer403
13. Husby VS, Helgerud J, Bjorgen S, Husby OS, Benum P, Hoff J
(2009) Early maximal strength training is an efficient treatment for
patients operated with total hip arthroplasty. Arch Phys Med
Rehabil 90(10):1658–1667. https://doi.org/10.1016/j.apmr.2009.
04.018
14. Hartog YM, Mathijssen NM, Vehmeijer SB (2015) Total hip
arthroplasty in an outpatient setting in 27 selected patients. Acta
Orthop 1–4. https://doi.org/10.3109/17453674.2015.1066211
15. Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH Jr,
Hamilton WG, Hozack WJ (2016) Otto Aufranc Award: a multi-
center, randomized study of outpatient versus inpatient total hip
arthroplasty. Clin Orthop Relat Res. https://doi.org/10.1007/
s11999-016-4915-z
16. Berger RA (2007) A comprehensive approach to outpatient total
hip arthroplasty. Am J Orthop 36(9 Suppl):4–5
17. Eneqvist T, Nemes S, Bulow E, Mohaddes M, Rolfson O (2018)
Can patient-reported outcomes predict re-operations after total hip
replacement? Int Orthop 42(2):273–279. https://doi.org/10.1007/
s00264-017-3711-z
18. Gromov K, Kjaersgaard-Andersen P, Revald P, Kehlet H, Husted H
(2017) Feasibility of outpatient total hip and knee arthroplasty in
unselected patients. Acta Orthop 1–7. https://doi.org/10.1080/
17453674.2017.1314158
19. Hunt GR, Crealey G, Murthy BV, Hall GM, Constantine P, O'Brien
S, Dennison J, Keane P, Beverland D, Lynch MC, Salmon P (2009)
The consequences of early discharge after hip arthroplasty for pa-
tient outcomes and health care costs: comparison of three centres
with differing durations of stay. Clin Rehabil 23(12):1067–1077.
https://doi.org/10.1177/0269215509339000
20. Mauerhan DR, Lonergan RP, Mokris JG, Kiebzak GM (2003)
Relationship between length of stay and dislocation rate after total
hip arthroplasty. J Arthroplast 18(8):963–967
21. Assi C, El-Najjar E, Samaha C, Yammine K (2017) Outcomes of
dual mobility cups in a young Middle Eastern population and its
influence on life style. Int Orthop 41(3):619–624. https://doi.org/10.
1007/s00264-016-3390-1
22. Ferreira A, Prudhon JL, Verdier R, Puch JM, Descamps L, Dehri G,
Remi M, Caton JH (2017) Contemporary dual-mobility cup region-
al and private register: methodology and results. Int Orthop 41(3):
439–445. https://doi.org/10.1007/s00264-017-3405-6
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