Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
Principles of preoperative and operative surgeryMEEQAT HOSPITAL
This document discusses principles of preoperative and operative surgery. It covers four main principles: preoperative preparation of the patient, a systems approach to preoperative evaluation, additional preoperative considerations, and a preoperative checklist. For preoperative evaluation and preparation, the document emphasizes assessing patient risk factors, especially cardiovascular risk, and optimizing high-risk patients prior to surgery through testing, medication, and consultation with specialists. The goal is to identify any medical issues that could impact the surgical outcome and take steps to improve the patient's status and reduce perioperative risk.
The document discusses recent advances in safer surgery. It defines safer surgery as reducing avoidable harm to surgical patients. Common causes of patient harm include errors by healthcare professionals, a complex healthcare system, and barriers during care. Standards, communication, and learning from incidents can help achieve safer surgery goals. The WHO surgical safety checklist provides a standardized 5-step process of briefing, sign in, time out, sign out, and debriefing to reduce errors and improve outcomes. Implementing changes gradually through repeated testing and feedback cycles allows for safer surgery initiatives to be successfully adopted.
The document discusses guidelines for day surgery. It notes that day surgery has expanded significantly due to advances in surgical and anesthetic techniques. National and international guidelines on patient care, admission/discharge processes, and running day surgery units have helped the growth of day surgery. The latest joint guidelines from 2019 provide recommendations such as thorough pre-assessment, determining fitness based on function rather than physical status, undertaking most surgeries as day cases, and trained multidisciplinary teams. Day surgery provides benefits to both patients, such as early mobility, and hospitals by freeing beds and reducing costs. A wide range of procedures are now suitable as day cases.
The document discusses international patient safety goals in hospital settings. It outlines 6 main goals: [1] Identify patients correctly; [2] Improve communication among caregivers; [3] Improve safety of high-alert medications; [4] Ensure correct procedures and patients; [5] Reduce health care-associated infections; [6] Reduce risk of falls. The goals aim to prevent medical errors and harm to patients by establishing safety protocols for identification, communication, medication use, surgery, infection control, and fall prevention.
This document discusses patient safety and clinical risk management. It defines patient safety as preventing harms, errors, and risks during healthcare provision. It also defines clinical risk management as improving quality and safety by identifying risks to patients. The document outlines principles of patient safety like proper patient identification. It also discusses common safety issues like medication errors and healthcare-associated infections. It describes technologies like barcoding and electronic health records that can enhance safety. Finally, it discusses the risk management process of identifying, assessing, and controlling risks in healthcare.
This document discusses patient safety in healthcare. It defines patient safety as the absence of preventable harm during healthcare. It notes that most patient harm is due to systemic flaws rather than individual negligence. It then discusses various types of patient safety concerns like medical errors, adverse events, infections, and falls. International patient safety goals are also presented, such as properly identifying patients, improving communication, and reducing healthcare-associated infections. The document emphasizes that improving safety requires efforts across many areas to protect patients from harm.
Slide deck cancer care during covid 19 pandemicmadurai
This document provides guidance for cancer care during the COVID-19 pandemic from several medical organizations. It discusses that cancer patients may be more susceptible to COVID-19 and have poorer outcomes. It recommends postponing non-urgent visits and elective surgeries, continuing critical cancer treatments when possible, and increasing telehealth to reduce infections. Safety measures like PPE and social distancing are crucial to protect staff and patients. Treatment should be individualized based on risk factors.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
Principles of preoperative and operative surgeryMEEQAT HOSPITAL
This document discusses principles of preoperative and operative surgery. It covers four main principles: preoperative preparation of the patient, a systems approach to preoperative evaluation, additional preoperative considerations, and a preoperative checklist. For preoperative evaluation and preparation, the document emphasizes assessing patient risk factors, especially cardiovascular risk, and optimizing high-risk patients prior to surgery through testing, medication, and consultation with specialists. The goal is to identify any medical issues that could impact the surgical outcome and take steps to improve the patient's status and reduce perioperative risk.
The document discusses recent advances in safer surgery. It defines safer surgery as reducing avoidable harm to surgical patients. Common causes of patient harm include errors by healthcare professionals, a complex healthcare system, and barriers during care. Standards, communication, and learning from incidents can help achieve safer surgery goals. The WHO surgical safety checklist provides a standardized 5-step process of briefing, sign in, time out, sign out, and debriefing to reduce errors and improve outcomes. Implementing changes gradually through repeated testing and feedback cycles allows for safer surgery initiatives to be successfully adopted.
The document discusses guidelines for day surgery. It notes that day surgery has expanded significantly due to advances in surgical and anesthetic techniques. National and international guidelines on patient care, admission/discharge processes, and running day surgery units have helped the growth of day surgery. The latest joint guidelines from 2019 provide recommendations such as thorough pre-assessment, determining fitness based on function rather than physical status, undertaking most surgeries as day cases, and trained multidisciplinary teams. Day surgery provides benefits to both patients, such as early mobility, and hospitals by freeing beds and reducing costs. A wide range of procedures are now suitable as day cases.
The document discusses international patient safety goals in hospital settings. It outlines 6 main goals: [1] Identify patients correctly; [2] Improve communication among caregivers; [3] Improve safety of high-alert medications; [4] Ensure correct procedures and patients; [5] Reduce health care-associated infections; [6] Reduce risk of falls. The goals aim to prevent medical errors and harm to patients by establishing safety protocols for identification, communication, medication use, surgery, infection control, and fall prevention.
This document discusses patient safety and clinical risk management. It defines patient safety as preventing harms, errors, and risks during healthcare provision. It also defines clinical risk management as improving quality and safety by identifying risks to patients. The document outlines principles of patient safety like proper patient identification. It also discusses common safety issues like medication errors and healthcare-associated infections. It describes technologies like barcoding and electronic health records that can enhance safety. Finally, it discusses the risk management process of identifying, assessing, and controlling risks in healthcare.
This document discusses patient safety in healthcare. It defines patient safety as the absence of preventable harm during healthcare. It notes that most patient harm is due to systemic flaws rather than individual negligence. It then discusses various types of patient safety concerns like medical errors, adverse events, infections, and falls. International patient safety goals are also presented, such as properly identifying patients, improving communication, and reducing healthcare-associated infections. The document emphasizes that improving safety requires efforts across many areas to protect patients from harm.
Slide deck cancer care during covid 19 pandemicmadurai
This document provides guidance for cancer care during the COVID-19 pandemic from several medical organizations. It discusses that cancer patients may be more susceptible to COVID-19 and have poorer outcomes. It recommends postponing non-urgent visits and elective surgeries, continuing critical cancer treatments when possible, and increasing telehealth to reduce infections. Safety measures like PPE and social distancing are crucial to protect staff and patients. Treatment should be individualized based on risk factors.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
Acs0005 Patient Safety In Surgical Care A Systems Approachmedbookonline
This document discusses patient safety in surgical care from a systems approach. It begins by defining key terms related to patient safety such as adverse events, errors, and preventable events. Several studies are cited that estimate the incidence of adverse events in surgery, finding rates between 3-4% resulting in half being preventable. Common preventable complications included infections, bleeding, and technical errors. Creating a just culture that views errors as systems failures rather than individual faults is important for improving safety.
Nephrology leadership program 4 patient safety in dialysis and nephrology au...Ala Ali
This document discusses patient safety in nephrology. It defines safety and harm, and provides the iceberg model of accidents and errors. It notes that adverse events during hospital admission occur in approximately 9% of patients and lead to death in 7% of cases. Many adverse events are preventable. Examples of errors in nephrology include adverse drug reactions, drug interactions, and failures to adhere to protocols. Implementing patient safety requires acknowledging problems, diagnosing issues, accepting responsibility for improvement, encouraging participation, standardizing care through guidelines, and ensuring adherence to guidelines.
Managing Complications; First Prevent Complications
Examples of ComplacencySleeve Gastrectomy Failure:
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will outline the care provided to trauma patients from point of injury through completion of care. The trauma team includes surgeons, nurses, and liaisons from emergency medicine, orthopedics, neurosurgery, anesthesia, and radiology, with the shared goal of improving trauma patient care in a consistent and caring manner and preventing injuries in the local region. Participants are asked to review provided materials and complete an evaluation.
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will explore various areas of interest throughout the year and outline the full continuum of care provided to trauma patients. The IEP involves the trauma team, which consists of physicians, nurses, and other specialists from various departments. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document discusses preoperative and postoperative care. The goals of preoperative care are to optimize the patient's condition before surgery to achieve the best surgical outcome and minimize complications. This involves assessing risk factors, performing examinations and tests to evaluate fitness for surgery, and developing a management plan. Postoperative care focuses on recovery and addressing any medical issues that arise.
Avoiding and Managing Complications During Gynaecological SurgeryAlex Swanton
All surgery involves a delicate balance of risk management, from the benefits and disadvantages of when a surgical option is appropriate, to the immediate post-operative care.
General surgeons are highly skilled medical professional who has a specialization in surgeries that cover many medical issues. Starting from the removal of gallbladders and tumors to fixing appendixes and hernias Best General Surgeon in Usa are equipped with the expertise and knowledge required to carry out a range of procedures.
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
Preventing mediastinitis surgical site infections executive summary of the a...ricardovilla
This executive summary outlines guidelines for preventing mediastinitis surgical site infections after cardiac surgery procedures. It discusses risk factors for mediastinitis, recommendations for surveillance and data collection on infection rates, and components of an effective mediastinitis prevention program. The prevention program should involve monitoring compliance with best practices, mitigating risks from non-modifiable patient factors, and implementing evidence-based improvement initiatives to continuously reduce infection rates.
The document discusses the increasing number and complexity of diagnostic and therapeutic procedures performed outside the traditional operating room, known as non-operating room anesthesia (NORA). It outlines some of the challenges of NORA including unfamiliar environments and limited resources. The document also covers important considerations for NORA such as pre-procedural patient evaluation and preparation, appropriate anesthetic techniques, monitoring during procedures, and post-procedural care.
This document discusses implementing mechanical VTE prophylaxis for outpatient surgeries. It begins with describing the increasing popularity and risk factors associated with outpatient surgeries. The proposed solution is to provide staff education on mechanical VTE prophylaxis through an in-service presentation and update preoperative checklists to include risk assessments and application of prophylaxis. An implementation plan involves obtaining approval from stakeholders, educating nursing staff, and revising checklists to ensure prophylaxis is consistently applied and continued into recovery and discharge.
Patient safety is a fundamental principle of healthcare. Adverse events may result from problems in practice, products, procedures or systems. Improving patient safety demands a complex, system-wide effort involving performance improvement, risk management, infection control, safe clinical practices, and a safe environment of care. Unsafe injections expose millions of people to infections worldwide each year. Ensuring single-use injection devices and safety boxes are available in every healthcare facility can prevent reuse and unsafe waste disposal.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
The document discusses the National Safety and Health Services Standard (NSHSS) in Australia, which aims to ensure consistent and high-quality healthcare across the country. It focuses on the Comprehensive Care Standard, particularly preventing falls and injuries from falls. This standard requires healthcare organizations to develop comprehensive care plans, deliver comprehensive care, and minimize patient harm through evidence-based policies and protocols to assess fall risk and provide safety equipment, education, and post-fall management. The case study examines applying this standard to care for an elderly patient at risk of falls and fall-related injuries.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
Drug Repurposing: Recent Advancements, Challenges, and Future Therapeutics fo...JohnJulie1
Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
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Acs0005 Patient Safety In Surgical Care A Systems Approachmedbookonline
This document discusses patient safety in surgical care from a systems approach. It begins by defining key terms related to patient safety such as adverse events, errors, and preventable events. Several studies are cited that estimate the incidence of adverse events in surgery, finding rates between 3-4% resulting in half being preventable. Common preventable complications included infections, bleeding, and technical errors. Creating a just culture that views errors as systems failures rather than individual faults is important for improving safety.
Nephrology leadership program 4 patient safety in dialysis and nephrology au...Ala Ali
This document discusses patient safety in nephrology. It defines safety and harm, and provides the iceberg model of accidents and errors. It notes that adverse events during hospital admission occur in approximately 9% of patients and lead to death in 7% of cases. Many adverse events are preventable. Examples of errors in nephrology include adverse drug reactions, drug interactions, and failures to adhere to protocols. Implementing patient safety requires acknowledging problems, diagnosing issues, accepting responsibility for improvement, encouraging participation, standardizing care through guidelines, and ensuring adherence to guidelines.
Managing Complications; First Prevent Complications
Examples of ComplacencySleeve Gastrectomy Failure:
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will outline the care provided to trauma patients from point of injury through completion of care. The trauma team includes surgeons, nurses, and liaisons from emergency medicine, orthopedics, neurosurgery, anesthesia, and radiology, with the shared goal of improving trauma patient care in a consistent and caring manner and preventing injuries in the local region. Participants are asked to review provided materials and complete an evaluation.
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will explore various areas of interest throughout the year and outline the full continuum of care provided to trauma patients. The IEP involves the trauma team, which consists of physicians, nurses, and other specialists from various departments. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document discusses preoperative and postoperative care. The goals of preoperative care are to optimize the patient's condition before surgery to achieve the best surgical outcome and minimize complications. This involves assessing risk factors, performing examinations and tests to evaluate fitness for surgery, and developing a management plan. Postoperative care focuses on recovery and addressing any medical issues that arise.
Avoiding and Managing Complications During Gynaecological SurgeryAlex Swanton
All surgery involves a delicate balance of risk management, from the benefits and disadvantages of when a surgical option is appropriate, to the immediate post-operative care.
General surgeons are highly skilled medical professional who has a specialization in surgeries that cover many medical issues. Starting from the removal of gallbladders and tumors to fixing appendixes and hernias Best General Surgeon in Usa are equipped with the expertise and knowledge required to carry out a range of procedures.
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
Preventing mediastinitis surgical site infections executive summary of the a...ricardovilla
This executive summary outlines guidelines for preventing mediastinitis surgical site infections after cardiac surgery procedures. It discusses risk factors for mediastinitis, recommendations for surveillance and data collection on infection rates, and components of an effective mediastinitis prevention program. The prevention program should involve monitoring compliance with best practices, mitigating risks from non-modifiable patient factors, and implementing evidence-based improvement initiatives to continuously reduce infection rates.
The document discusses the increasing number and complexity of diagnostic and therapeutic procedures performed outside the traditional operating room, known as non-operating room anesthesia (NORA). It outlines some of the challenges of NORA including unfamiliar environments and limited resources. The document also covers important considerations for NORA such as pre-procedural patient evaluation and preparation, appropriate anesthetic techniques, monitoring during procedures, and post-procedural care.
This document discusses implementing mechanical VTE prophylaxis for outpatient surgeries. It begins with describing the increasing popularity and risk factors associated with outpatient surgeries. The proposed solution is to provide staff education on mechanical VTE prophylaxis through an in-service presentation and update preoperative checklists to include risk assessments and application of prophylaxis. An implementation plan involves obtaining approval from stakeholders, educating nursing staff, and revising checklists to ensure prophylaxis is consistently applied and continued into recovery and discharge.
Patient safety is a fundamental principle of healthcare. Adverse events may result from problems in practice, products, procedures or systems. Improving patient safety demands a complex, system-wide effort involving performance improvement, risk management, infection control, safe clinical practices, and a safe environment of care. Unsafe injections expose millions of people to infections worldwide each year. Ensuring single-use injection devices and safety boxes are available in every healthcare facility can prevent reuse and unsafe waste disposal.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
The document discusses the National Safety and Health Services Standard (NSHSS) in Australia, which aims to ensure consistent and high-quality healthcare across the country. It focuses on the Comprehensive Care Standard, particularly preventing falls and injuries from falls. This standard requires healthcare organizations to develop comprehensive care plans, deliver comprehensive care, and minimize patient harm through evidence-based policies and protocols to assess fall risk and provide safety equipment, education, and post-fall management. The case study examines applying this standard to care for an elderly patient at risk of falls and fall-related injuries.
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Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
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Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
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The imbalance of sodium and chloride ions occurs frequently in patients with lung cancer. However, the correlation between ion concentration change and patients prognosis have not been studied thoroughly. Our research will fill the gap, especially for high ion concentration.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...JohnJulie1
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...JohnJulie1
The IRF family of proteins involves in the tumor progression. However, but the functions of IRF5 in the tumorigenesis are largely unknown. Here, IRF5 was found to be up-regulated in hepatocellular carcinoma (HCC). Interfering with IRF5 inhibited the growth and tumorigenic ability of HCC cells.
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Fibrous
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Fibro glandular
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Adipose (Fatty)
What is Tomosynthesis?
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Is a 3 dimensional projection
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Reduces overlapping tissue seen with 2D only
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15 projections are taken with each combo exposure (7.5) (-7.5)
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With an average breast (18*24) 3D dose is 1.34, combo is 2.56 Milligrey. (3 Milligrey FDA) (2D is 1.2
Alterations of Gut Microbiota From Colorectal Adenoma to CarcinomaJohnJulie1
Gut microbiota has been implicated as a critical role in the development of colorectal cancer (CRC) and colorectal adenoma (CRA). However, few basic research has revealed the association between gut microbiota and the development of CRA and CRC. We aim to compare the diversity and composition of intestinal flora in CRA and CRC patients, to reveal the changes of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis, and to explore potential biomarkers.
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Liquid Chromatography Tandem Mass Spectrometry
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Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
The Use of the Infrared Laser Therapy of 890-910 NM for the Treatment Breast ...JohnJulie1
The document summarizes experimental and clinical research on using infrared laser therapy between 890-910 nm to treat breast cancer. Experimental studies showed that lower doses of laser therapy (0.46 J/cm2) inhibited tumor growth more than higher doses. Laser therapy combined with chemotherapy was also effective, particularly with vincristin. Clinical studies on 136 breast cancer patients found that laser therapy before or after surgery, or alone, reduced complications, improved immune function and quality of life, and increased survival time. Histological analysis found over 50% tumor tissue disappeared after effective laser treatment.
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...JohnJulie1
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Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions.
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Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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Your smile is beautiful.
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low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
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consensus that the potential benefits of surgery outweigh the po-
tential associated risks.
Co-morbidity increases the risk of surgical procedures and mini-
mizing that risk is vitally important to improve the individual out-
come [3]. Risk assessment is also important in terms of outcome
measures for comparative audit. Simple scales, such as the Amer-
ican Society of Anesthesiologists (ASA) grading system, are open
to varied interpretation among experienced medical assessors,
while more complex systems such as the POSSUM score, are too
complex for most daily clinical applications.
Co-existing diseases can complicate even a simple operation and
increase morbidity and mortality. The level of care required needs
to be anticipated with consideration given to transfer to units with
appropriate facilities and/or to gaining disease directed expertise
to advise on pre-operative optimisation and peri-operative man-
agement of individual co-morbidities.
The concept of a ‘high-risk’patient is generally understood but the
key is to recognise the factors contributing to that perceived risk
and repeatedly (re)assessing these patients throughout their stay in
hospital to minimise the risk of developing complications.
Good surgical results reflect the quality of care. This depends on:
• surgical factors, relating to pre-, intra- and postop-
erative care
• patient factors, regarding disease presentation and
pre-existing co-morbidities
• systemic factors that relate to the resources available
for the treatment of surgical patients
Once risks have been identified and assessed, the techniques to
manage the risk can be placed into four categories [4]. Risk trans-
fer refers to the organization transferring all or part of the losses
to another party (i.e. insurance company). Risk avoidance means
that the facility does not participate in any activities that may place
itself in a position where an event may occur. This may include
refusing to schedule a procedure secondary to a patient’s preex-
isting medical history or surgical risk. Risk retention means that
the facility retains the entirety of the losses accrued by an event.
Parties that are self-insured may elect to proceed in this manner.
Risk control refers to the redesign of policies and procedures in
hopes that future exposures are mitigated. How an ASC (ambula-
tory surgery center) decides to proceed in treating a risk depends
on the its unique setting and the circumstances surrounding it. The
risk management team must consider factors including staffing,
resources, and competencies while understanding various limita-
tions when determining which treatment to apply. A free-standing
surgery center remotely located from emergency medical services
may opt to refuse a surgery while an ASC in close proximity to a
large hospital may elect to perform the procedure or accept pa-
tients with a higher acuity. There are no decisions that universally
apply to ASCs. The role of a risk management team is to decide
what issues are the most threatening and pertinent to its practice
and plan accordingly
3. General Problems
3.1 Age
Problems occur at the extremes of life [5]. There are limits to car-
diac, respiratory and renal reserves in the elderly. Fluid overload
is tolerated poorly. Smaller doses of narcotics, sedatives and anal-
gesics are required.
3.2 Obesity
This often results in poor wound healing and a higher incidence of
respiratory problems. DVT (deep venous thrombosis) and PE (pul-
monary embolus) are more common. Pressure sores can develop.
Delay elective surgery until the patient loses weight.
3.3 Compromised host
There is reduced response to trauma and infection, e.g. immuno-
suppressive drugs or uraemia. Malnutrition, e.g. vitamin deficien-
cies or liver disease, can also be a factor. Allergies Check for these
preoperatively. Unsuspected reactions may occur. In severe cases,
anaphylactic shock may result. Sensitivity to surgical dressings
(e.g. Elastoplast) may occur.
3.4 Drugs
Current drugs should be monitored carefully, e.g. insulin and ste-
roids. Diabetics may require conversion to sliding scale insulin.
Patients on steroids may need to continue their normal dose but
with major surgery have additional steroid cover. Adjust antico-
agulant therapy, e.g. conversion from warfarin to heparin over the
perioperative period. Clopidogrel is contraindicated with region-
al anaesthesia (may cause epidural haematoma). Aspirin does not
generally pose a problem in general surgical procedures.ACEI and
ATII inhibitors should be stopped 24 h before surgery to prevent
severe and refractive hypotension.
3.5 Breast Cancer
If we consider hereditary breast cancer development, current data
coming from basic research confirm that the genetic predisposition
is 5-10% [6]. Women with BRCA1 or BRCA2 mutation have a
cumulative risk of invasive cancer ranging from 55 to 85% and
of invasive epithelial ovarian cancer ranging from 15 to 65%. The
risk of developing breast cancer increases near the age of 25 years.
The identification of breast cancer susceptibility genes BRCA1 or
BRCA2 was performed in 1994 and 1995 respectively according
to the evidence of premature truncation of the BRCA1 or BRCA2
protein. Modern prophylactic surgery for women at high risk of
breast cancer, according to the molecular tests, include total bilat-
eral mastectomy (TBM) without axillary lymph node dissection,
skin-sparing total mastectomy, and subcutaneous nipple-sparing
mastectomy, reconstruction with artificial breast implants or tis-
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sue reconstruction options using transverse rectus abdominis flap
and the latissimus dorsi flap. A final procedure being discussed is
areolar-sparing mastectomy. The efficacy of prophylactic TBM in
reducing the incidence of breast cancer at three years of follow-up
has been demonstrated. Prophylactic TBM reduced the risk of
breast cancer by 95% in women who also had a risk-reducing salp-
ingo-oophorectomy and by 90% in women that had intact ovaries.
Prophylactic surgery is a highly personal decision and the protec-
tive effects of surgery must be weighed according to possible com-
plications and psychological problems.
3.6 Bowel Malignancy
Surgical decision making for MBO (malignant bowel obstruction)
requires the highest degree of clinical judgment and thoughtful
communication with patients and families [7]. Perhaps the most
fundamental decision is the one regarding the need and benefit of
surgical intervention. Because MBO rarely requires intervention
within the first few hours of presentation, there is usually adequate
time to counsel the patient and family. Surgical intervention for
MBO aims to reduce symptoms and improve the quality of life but
does not address the underlying incurable malignancy. However,
relieving the obstruction may improve nutritional intake, prevent
perforation and ischemia and prolong life.
Patient factors associated with worse surgical outcomes include
advanced age, poor nutritional status, comorbidities, persistent as-
cites, poor performance status, prior abdominal radiation therapy,
and failed prior surgery for MBO. Poor nutritional status and poor
performance status are each associated with 3 times higher odds
of dying after surgery. Although not absolute contraindications to
surgery, these factors greatly increase surgical risk, and potential
benefits of surgery must be weighed against increased potential for
complications.
Given the overall poor prognosis for patients with incurable cancer
and MBO, a thorough discussion should take place before surgery
between the surgeon, patient, and family to elicit the patient’s goals
for treatment and set reasonable expectations for recovery and out-
comes. Patients have differing degrees of disease awareness, so it
is helpful to initiate the conversation by determining the patient’s
and family’s understanding of their disease and prognosis. This
will allow the surgeon to place the acute MBO in the context of
underlying disease. The surgeon should then inform the patient
and family about the acute problem, explaining the disease course
of MBO and its likely impact on the patient’s health trajectory. If
at all possible, it is advisable to engage other treating clinicians,
including the patient’s oncologist, in discussions about prognosis,
potential outcomes, and treatment decisions.
3.7 Mental State
Surgery is a traumatic event and these factors have considerable
potential in affecting its outcome [8]. Preoperative psychological
morbidity, as well as making the assessment of presenting symp-
toms and surgical risks more difficult, increases the risk of post-
operative complications such as delirium, cognitive impairment
and functional disability. The changes in surgical practice, with
increasing use of day surgery and the reduced length of hospital
admissions, have further highlighted the need to consider these
issues.
Psychiatric illness may lead to miscommunication, inaccurate
diagnosis and potentially inappropriate surgery, and poor postop-
erative adjustment. Therefore, the evaluation of the current men-
tal state in patients being considered for surgery is essential. The
ability to comply with postoperative management, especially im-
portant in transplantation surgery where immune suppressants are
required, may affect the decision to proceed with the surgery, and
should be included in the preoperative assessment. The assessment
should also take account of the personal circumstances of the pa-
tient, their illness and the surgical procedure itself, as these fac-
tors will affect their response. Surgery affecting body parts with
significant emotional and symbolic meaning (e.g., head and neck,
breast, testes) raise specific concerns and anxiety about potential
disfigurement.
3.8 Stress
Because of the physiologic stress caused by surgery, catechol-
amines including adrenaline (epinephrine) and noradrenaline
(norepinephrine) are released as a result of the activation of the
hypothalamic–pituitary–adrenal axis [9]. Emotional stress has also
been shown to increase the production and release of cortisol. This
additional cortisol can affect the postoperative patient, for example
by increasing metabolism, water excretion, cardiovascular tone,
temperature, and blood glucose levels. Cortisol also diminishes in-
flammation by suppressing the body’s immune response, thereby
hindering wound healing.
As a result of the body’s physiologic response to stress and the
inherent surgical risk of hemorrhage and shock, regular postop-
erative observations are essential in maintaining patient care. The
nature of the operation, the patient’s condition, and the method of
pain control will determine how regularly such observations need
to be performed. A reduction in systolic blood pressure can in-
dicate hypovolemic shock, which can ultimately lead to multiple
organ failure. However, it is important to note that blood pressure
measurements can be variable due to the body’s compensatory
mechanisms. Therefore, it is useful to consider the early signs of
reduced tissue perfusion when detecting signs of shock. These in-
clude increased respiratory rate and tachycardia as a precursor to
hypotension, low urine output (<0.5 mL/kg per hour), restlessness
or confusion, and cold peripheries.
4. Tips
In TIPS (transjugular intrahepatic portosystemic shunt), a tech-
nique developed to create a portal-systemic shunt by a percuta-
neous approach, an expandable metal stent is advanced under
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angiographic guidance to the hepatic veins and then through the
substance of the liver to create a direct portacaval channel [10].
This technique offers an alternative to surgery for refractory bleed-
ing due to portal hypertension. However, stents frequently undergo
stenosis or become occluded over a period of months, necessitat-
ing revision, a second TIPS, or an alternative approach. Encepha-
lopathy may occur after TIPS, just as in the surgical shunts, and is
especially problematic in the elderly and those patients with pre-
existing encephalopathy. TIPS should be reserved for those indi-
viduals who fail endoscopic or medical management and are poor
surgical risks. TIPS sometimes serves a useful role as a “bridge”
for those patients with end-stage cirrhosis awaiting liver transplan-
tation. Procedures such as esophageal transection have also been
advocated for the management of acute variceal bleeding, but their
efficacy remains unproven, and these procedures are usually con-
sidered a last resort.
The management of bleeding gastric fundal varices, found either
alone or in conjunction with esophageal varices, is more problem-
atic, since banding and sclerotherapy are generally not effective.
Vasoactive pharmacologic therapy should be instituted, but TIPS
or shunt surgery should be considered because of high failure and
rebleeding rates. For isolated gastric varices, splenic vein throm-
bosis should be specifically sought, since splenectomy is curative.
5. Proxy
Part of the preoperative assessment of any patient is consideration
of underlying comorbid conditions as they relate to a patient’s
overall outcome [11]. This is necessary for any patient, regardless
of their age, but it is of particular importance in older patients.
Older patients may not be able to handle severe stress as well as
younger patients; therefore, optimal preoperative preparation is
essential, and attention to detail intra- and preoperatively is essen-
tial to reduce risk. There are many tools to evaluate the affect that
comorbid conditions have on surgical risk and outcomes, and risk
calculators are essential to take these conditions into account.
Once a healthcare proxy has been identified and invited to join
the conversation, surgeons need to then paint the picture of what
the recovery process is like [12]. This should include in-hospital
postoperative care and expectations beyond the hospital after the
patients are discharged. When the prognosis is not clear, the most
helpful approach to establish a range of outcomes is by describ-
ing the “best-case/worst-case” scenarios. This range of outcomes
should be personalized to individual patients, rather than simply
reporting numbers such as the expected in-hospital or 30-day mor-
tality.
Additionally, using objective prognostic tools may be valuable in
certain situations. The ACS (abdominal compartment syndrome)
National Surgical Quality Improvement Program (NSQIP) Surgi-
cal Risk Calculator, which is readily available online, offers esti-
mated risks of postoperative complications based on specific pa-
tient characteristics along with the type of planned procedure and
whether it is an emergency case. For geriatric patients specifically,
age or comorbidities alone do not predict outcomes; frailty has
been shown to independently predict postoperative complications,
length of stay, and discharge to facilities in older surgical patients.
Utilizing these adjunctive tools for prognostication may provide
surgeons and patients a common ground to establish expected out-
comes for shared decision-making.
Once both parties agree regarding expectations, the goals of care
conversation continues with gathering more information regarding
their preferences for life support and advance directives. Some pa-
tients may opt out of surgery once they find out about the expected
outcomes. Others may elect to have surgery but will ask to enact a
do-not-resuscitate order and will indicate that if they do not recov-
er well, they would not want to be kept alive on mechanical sup-
port. Hence, it is essential to have a GOC (goals of care) discussion
preoperatively, even in the emergency setting, to ensure that pa-
tients receive the treatments that are aligned with their preferences
postoperatively. The discussion about advance directives is diffi-
cult—patients have a hard time considering their own mortality,
and it is especially difficult when faced with a surgical emergency.
Patients may simply state that they are comfortable with a named
proxy making end of life decisions on their behalf. No matter what
decisions are made, this is a good time to provide assurances that
the patient will be well cared for throughout their hospitalization
and that these concepts can be revisited at any time. Closing the
GOC discussion by determining if the patient or surrogate has any
new questions, concerns, or worries may shed additional light on
the patient’s wishes, goals, and even advance directives; practical-
ly speaking, addressing new concerns helps ease the patient into
the next step of his or her care.
6. Conclusion
Medical evaluation performed before surgery is very important
in order to better define the type of surgery that each person can
or cannot do and to determine if the risks outweigh the benefits.
Understanding the type of surgery that will be done is also very
important, because the more complex and time-consuming the op-
eration, the greater the risks that the patient may suffer. From the
obtained data it is possible to determine the surgical risk. So if it
is low, it is possible to dismiss the surgery, if the surgical risk is
medium to high, the doctor can give guidance, adjust the type of
surgery or request more tests to help better assess a person’s sur-
gical risks.
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