Dissertations / Theses on the topic 'Surgical patients'
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1
Nohr, Carl William. "Humoral immunity in surgical patients." Thesis, McGill University, 1988. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=75969.
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Humoral immune function was studied in surgical patients. The antibody response to vaccination with a protein antigen, tetanus toxoid (TT), was reduced among all patients, especially those with reduced delayed type hypersensitivity (DTH) and increased degree of physiological derangement. The antibody response to a polysaccharide antigen, pneumococcal polysaccharide (PPS), was normal. In trauma patients, the antibody response to TT was normal. The in vitro production of specific and total immunoglobulin (Ig) by blood mononuclear cells was studied. Patients that failed to produce a serum antibody response to TT also failed to produce anti-TT in vitro. Anti-PPS production was normal. More total Ig was produced by patients, especially those with reduced DTH responses. Some patients showed a reduction, rather than the normal increase, in Ig synthesis with mitogen stimulation. These data show evidence of humoral immune deficiency to protein antigens, and in vivo activation of the B cell system.
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Yan, Tristan D. "Surgical management of diffuse malignant mesothelioma." Thesis, The University of Sydney, 2010. https://hdl.handle.net/2123/28975.
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The focus of this MS. thesis is the surgical management of both malignant pleural and peritoneal mesothelioma. Section I of this dissertation is devoted to the management of malignant pleural mesothelioma. In Chapter 1, a systematic review on extrapleural pneumonectomy-based multi-modality treatment is presented. Chapter 2 is a critical analysis of prospectively collected data on surgical management of pleural mesothelioma. Chapter 3 focuses on extrapleural pneumonectomy and Chapter 4 examines the pattern of recurrence following extrapleural pneumonectomy. Section II of the dissertation is dedicated to the management of malignant peritoneal mesothelioma. As part of my research, I conducted a multicenter registry study on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma. Chapter 5 reviews the current literature on the combined treatment approach for peritoneal mesothelioma. Chapter 6 analyzes the prognostic indicators and survival results of 405 patients with peritoneal mesothelioma from this multicenter registry. In the final chapter, a novel tumor—node-metastasis (TNM) staging system for peritoneal mesothelioma is proposed.
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Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients." Doctoral thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Abelha, Fernando José Pereira Alves. "Outcome in surgical critical care patients." Tese, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/55332.
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Stidham, Cova Teresa. "Depression Screening for Bariatric Surgical Patients." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6866.
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Obesity in the United States has increased to epidemic numbers over the last decade. Practitioners need to reverse the trend. To address the problem of depression in obesity, a practice guideline from a bariatric clinic for under-served populations was proposed to an expert panel. The Spell Out on First Use (PHQ-9) screening is a valid and reliable self-screening tool to assist the practitioner in determining the level of depression if any. The PHQ-9 has nine questions. No formal screening existed at the bariatric clinic, and the practice guideline (with algorithm and revised workflow) was proposed for use at the clinic. The expert panel consisted of the medical director, a surgeon, a psychiatrist, and a nurse practitioner at the clinic. The expert panel reviewed the materials and made one recommendation: to implement the PHQ-9 upon intake when the patient is being admitted to the program, and the panel recommends administering PHQ-9 prior to assessment by practitioners All panel members were in agreement about full implementation of the practice guideline, provided that an educational program on the revised workflow in the clinic was first presented. The expert panel also reviewed and approved the algorithm and the treatment pathways identified for patients to use in the practice after the results of the PHQ-9 are compiled. It is expected that use of the depression screening tool and recommended guidelines in the bariatric clinic will result in more effective treatment for the patients and thus better outcomes-a significant positive social change.
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Anderson, Alexander Douglas Gray. "Measurement of intestinal permeability in surgical patients." Thesis, University of Edinburgh, 2004. http://hdl.handle.net/1842/24575.
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Aim: The aim of this study was to investigate the use of a triple sugar test of intestinal permeability as a surrogate marker of gut barrier function in surgical patients. Methods: Original laboratory work included the development of a technique for the quantification of urinary sucralose using high performance liquid chromatography (HPLC) with refractive index detection. Other techniques used included HPLC analysis of urinary lactulose and rhamnose, quantification of urinary 51Cr-EDTA by gamma counting, and a lactulose-hydrogen breath test. The triple sugar test involved ingestion of a test drink containing sucralose (5g), lactulose (5g) and rhamnose (1g). Urine was collected for 24 hours in 2 aliquots (first 5 and last 19 hours) and sugar concentrations determined by HPLC. A 51Cr-EDTA test was administered separately as an independent measure of “whole-gut” permeability. Healthy volunteers (n=21) and ileostomists (n=18) were studied in order to investigate the sites of absorption of sugar probes. A number of patient groups were then studied; these included subjects with Crohn’s disease (n=16),acute colitis (n=18), IBS (n=11), acute pancreatitis (n=9) and patients undergoing chemotherapy (n=7). Results: Assays for urinary sugars were both accurate and precise (coefficient of variation approximately 5%). Studies in ileostomists and controls indicated that 24-hr sucralose excretion represented “whole-gut” permeability, whereas the 5-hr lactulose/rhamnose excretion ratio represented small intestinal permeability. Small intestinal permeability was increased in subjects with Crohn’s disease (p=0.007) and acute pancreatitis (p=0.004), versus controls. “Whole gut” permeability was significantly increased in patients with Crohn’s (p=0.001) and pancreatitis (p<0.001), and significantly reduced in patients undergoing chemotherapy (p=0.012). The proportion of sucralose excreted in the last 19 hours of collection was significantly increased in patients with Crohn’s (p=0.026), acute colitis (0.023) and acute pancreatitis (p=0.049), implying an increase in colonic permeability.
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Liu, Si. "B lymphocyte function in surgical anergic patients." Thesis, McGill University, 1988. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=64094.
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Scott, Eileen Margaret. "Hospital acquired pressure sores in surgical patients." Thesis, Teesside University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417233.
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Muryniuk, T. I. "Features of surgical preparation of orthodontic patients." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19126.
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Gregory, Sabrina. "Managing Acute Pain in Postoperative Surgical Patients." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3030.
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Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, and imaginary scenes to help heal the body in addition to using relaxation techniques and mental images for the management of pain. This project included the translation of evidence into practice using guided imagery on a 25-bed same day surgery unit (N = 34 patients), guided by Kolcaba's comfort theory. The findings of this project included using guided imagery for same day surgery patients who rated their pain greater than 4 on the traditional pain scale of one to ten, with one equaling no pain and ten equaling worst pain. The results of the evaluation showed a significant decrease in pain scores between premedication to postmedication (p < 0.001), premedication and postguided imagery (p < 0.001), and postmedication and postguided imaginary (p < 0.001). Guided imagery has been demonstrated to be efficient and cost effective methods to reducing pain. This project indicated that use of nonpharmacological and pharmacological interventions working together could be more effective for pain management in same day surgical patients.
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Lou, Meei-Fang. "Cognitive disturbance among elderly Taiwanese patients after elective surgery /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7360.
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Nixon, Jane Elizabeth. "Predicting and preventing pressure sores in surgical patients." Thesis, University of Newcastle Upon Tyne, 2001. http://hdl.handle.net/10443/393.
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The thesis comprises literature reviews which present arguments novel to the field and two discrete but related studies, which in combination make a contribution to the classification, assessment of risk and prevention of pressure sores. The first study, a randomised controlled trial involving 446 patients undergoing vascular, general and gynaecology surgery, the use of a dry visco-elastic polymer pad intra-operatively reduced the probability of pressure sore development by half. Pressure sore incidence was 11 % (22/205) for patients allocated to the dry polymer pad and 20% (43/211) for patients allocated to the standard operating table mattress. Both studies explored key prognostic factors using multi-variate methods. Analysis of data derived from the randomised controlled trial found four factors to be independently associated with post-operative pressure sore development including intra-operative hypotensive episodes, Day I Braden mobility scale and intraoperative mean core temperature. The second study, a prospective cohort study involving 101 patients identified non-blanching erythema, pre-operative albumin, weight loss preceding admission and intra-operative minimum diastolic blood pressure. Results are consistent with findings from the literature review which identified key factors in the prediction of pressure sore development (reduced mobility, nutrition, perfusion, age and skin condition). The second study also explored the clinical significance of erythema in defining and classifying the term 'pressure sore'. Using laser Doppler imaging it was determined that blanching and non-blanching erythema are characterised by high blood flow of differing intensity. Discriminant analysis identified three general patterns in skin blood flow, which enabled scan classification with good agreement between clinical and predicted classifications. The results confirm data derived from the prospective observations of skin suggesting that non-blanching erythema is not indicative of irreversible ischaemic damage and resolves in approximately two thirds of cases. The point at which non-blanching erythema becomes irreversible remains unknown
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McNaught, Clare-Ellen. "Synbiotics and gut barrier function in surgical patients." Thesis, University of Aberdeen, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.425019.
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The aim of this thesis was to study the effect of symbiotic administration on measurable parameters of gut-barrier function and clinical outcome in the following groups of surgical patients; Elective surgical admissions, Intensive Care patients, Irritable Bowel Syndrome sufferers and Crohn’s Disease patients. Each study was performed as a double blind, randomised and placebo controlled trial. The symbiotic preparation contained oligofructose and the probiotic bacteria Lactobacillus acidophilus La5, Bifidobacterium lactis Bb-12, Streptococcus thermophilus and Lactobacillus bulgaricus. The preoperative ingestion of synbiotics had no influence on the rate of bacterial translocation, endotoxin exposure or subsequent septic morbidity in elective surgical patients. Nasogastric colonisation by potentially pathogenic organisms was significantly reduced in the population of critically ill patients after symbiotic therapy, but was not associated with improved clinical outcome. Physical and psychological symptom scores improved in both the placebo and active symbiotic groups of irritable Bowel Syndrome patients, representing a significant placebo response. Synbiotic dietary supplementation had no significant effect on relapse rate, markers of disease activity or nutritional status in patients with Crohn’s Disease over a one year period. Synbiotic administration significantly altered nasogastric colonisation by potentially pathogenic bacteria, but had no effect on any other quantifiable measure of gut-barrier function. The clinical significance of this finding is uncertain, but warrants further investigation. To date, there is insufficient scientific evidence to recommend the routine use of synbiotics in surgical patients.
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Masterson, Lisa M. "Implementing a Glycemic Management Protocol with Surgical Patients." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1619806592278265.
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Ogunjulugbe, Jacqueline P. "Decreasing Operating Room Delays for Surgical Orthopedic Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6078.
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The operating room (OR) at the project site was experiencing surgical delays for orthopedic surgical patients due to unavailable instruments, which led to a decrease in the efficiency of OR utilization. The purpose of this project was to decrease operating room delays for the orthopedic surgical patients. The practice-focused question explored whether a multidisciplinary approach to the procurement of instruments and supplies for the orthopedic surgical patient would help to ensure an on-time surgery start, resulting in increased efficiency in the utilization of the OR from 42% to 65% within a 9-month period. Lewin's change model was used to guide the project. Data analysis was conducted using a t test to compare the changes in the mean scores of the OR utilization rate before and after the involvement of a multidisciplinary team. An independent samples t test found no significant effect of the intervention, t (13) = 0.74, p > .05. Because the t test results were not significant at the α = .05 level, results showed no evidence that the multidisciplinary team affected the OR utilization rate. Decreasing surgical delays can have the potential implication for positive social change at the organization level, because delays hinder optimal patient flow, increase anxiety for patient and families, and have a significant negative economic impact on hospitals.
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Little, Charlene Knight. "Decreasing Surgical Site Infections in Vascular Surgery Patients." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2412.
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Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, protocol, and practice guidelines developed based on recommended practices of the Association of periOperative Registered Nurses and current peer-reviewed literature. An interdisciplinary project team of institutional stakeholders was used to insure context-relevant operationalization of the evidence in practice. The team was assembled, led in a review of relevant literature, and convened regularly until project products were finished. Three scholars with expertise in the content area were then identified by the project team and asked to validate the content of developed products. Products were revised according to expert feedback. Implementation and evaluation plans were developed by the project team to provide the institution with all necessary process details to carry out the practice change. The evaluation plan advises using a retrospective chart review to compare rates of infection between patients receiving chlorhexidine skin preparation with showers and preoperative chlorhexidine cloths alone. A positive outcome could contribute to positive social change by decreasing preventable infections.
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Marsicano, Daniela. "The association between preoperative anaemia and surgical mortality and morbidity in South African surgical patients." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31104.
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Background: In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa. The demographics of South African surgical patients differ from those of the European and Northern American surgical patients where the preoperative anaemia data are derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to South African surgical patients. Objectives: The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in South African adult noncardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and i) critical care admission, and ii) length of hospital stay, and to describe the prevalence of preoperative anaemia in adult South African surgical patients. Methods: We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS) – a large, prospective, observational study of patients undergoing in-patient noncardiac, non-obstetric surgery at 50 hospitals across South Africa over a one-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis, which included all the independent predictors of mortality and admission to critical care identified in the original SASOS model. Results: The prevalence of preoperative anaemia was 1727/3610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.66, 95% confidence interval (CI) 1.06-2.60, p=0.028) and admission to critical care (OR 1.49, 95% CI 1.08-2.05, p=0.015). Conclusion: Almost 50% of patients undergoing surgery at government-funded hospitals in South Africa had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear opportunity for quality improvement programmes which may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, it behoves perioperative clinicians in all specialities to educate themselves in the principles of patient blood management.
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Seymour, David Gwyn. "Prediction of risk in the elderly surgical patient." Thesis, University of Birmingham, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326966.
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Frensley, Susan J. Franks Susan F. "Predicting weight loss in post surgical laparoscopic banding patients." [Denton, Tex.] : University of North Texas, 2007. http://digital.library.unt.edu/permalink/meta-dc-3672.
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Kim, Do Jun 1974. "Responsive measures to short-term prehabilitation in surgical patients." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=84047.
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The purpose of this study was to identify the most responsive measure of aerobic fitness over a four week pre-surgical aerobic training program (prehabilitation) in patients undergoing major bowel resection. Twenty one subjects (14 in exercise, 7 in control) participated. Fourteen subjects underwent 26.5 +/- 8.6 days of progressive aerobic exercise training at 40 to 65% of heart rate reserve (%HRR). The results showed that peak power output was the only maximal measure that responded to training as it improved by 26 +/- 27% (ES = 0.24, SRM = 1.05) in the exercise group (p < 0.05) compared to no change in the control group. For the submaximal measures, 6-Minute Walking Test improved in both group. Submaximal V·O2 (V·O2submax) and Submaximal Heart Rate (HR submax) were the most responsive to training as they decreased by 13 +/- 15% (ES = -0.24, SRM = -0.57) and 7 +/- 6% (ES = -0.40, SRM = -0.97) at 76 +/- 47 W compared to no change in the control group.
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Reddy, Bala Satyanarayana Murthy. "Bacterial translocation and gut barrier function in surgical patients." Thesis, University of Hull, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.445318.
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Simmons, Kingsley Lorraine. "The uptake of post-surgical treatment in cancer patients." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.416863.
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Frensley, Susan J. "Predicting Weight Loss in Post Surgical Laparoscopic Banding Patients." Thesis, University of North Texas, 2007. https://digital.library.unt.edu/ark:/67531/metadc3672/.
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The present study was a retrospective chart review (N=128) that investigated the efficacy of profiles derived from the three factors of the Eating Inventory® test (EI) - cognitive restraint, disinhibition, and hunger - to predict successful weight loss in post surgical laparoscopic banding patients at 6 and 9 months post surgery. Although the EI is commonly used in bariatric presurgical assessment, few studies have found consistent relationships between presurgical factor scores and subsequent weight loss in this population. Based on restraint theory, 7 profiles (high CR, super high CR, high D, super high D, high H, super high H, and null) were derived from the raw scores on the subscales of the EI and tested for weight loss predictive ability using direct logistic regression. Results were mixed with high CR, super high CR, and null profiles accurately predicting successful weight loss. Raw scores on the three factors (cognitive restraint, disinhibition, and hunger) were tested individually for predictive ability using direct logistic regression. Overall results indicated that the profile model accurately predicted more cases than the general factor model. This study significantly contributes to both the bariatric presurgical assessment literature and the restraint theory literature. Suggestions for future research are offered.
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余碧華 and Pik-wa Yu. "Evidence-based patient education programme on reducing pre-operative anxiety level in surgical patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251791.
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Dinwiddie, Lisa Taylor 1951. "A COMPARISON OF NURSE-PATIENT PERCEPTIONS OF PATIENTS' SURGICAL INTENSIVE CARE UNIT ORIENTATION NEEDS." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/275535.
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Yu, Pik-wa. "Evidence-based patient education programme on reducing pre-operative anxiety level in surgical patients." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251791.
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Säfwenberg, Urban. "Presenting complaint and mortality in non-surgical emergency medicine patients." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8583.
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In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs).
For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001).
Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern.
In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits.
Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.
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Chambers, Anthony James St Vincent's Hospital UNSW. "The surgical management of patients with human immunodeficiency virus infection." Awarded by:University of New South Wales. St. Vincent's Hospital, 2001. http://handle.unsw.edu.au/1959.4/19367.
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Infection with the human immunodeficiency virus (HIV) is a major cause of morbidity and death globally, and the number of individuals infected with this virus is increasing in many nations. Advanced HIV infection causes immunocompromise that predisposes to opportunistic infections and malignancies that characterise the acquired immunodeficiency syndrome (AIDS). Although the management of many of these AIDS-associated infections and malignancies is by medical means, surgeons play an important role the diagnosis and management of many of these conditions. Furthermore, patients with HIV infection may present with surgical disorders or traumatic injuries that are not related to HIV or AIDS. Health care workers managing patients with HIV infection and AIDS, particularly those involved in performing invasive procedures, are at risk of exposure to this virus in infected blood and body fluids. St. Vincent's hospital, Sydney, is a teaching hospital and major treatment centre for patients with HIV infection and AIDS located in the inner-eastern suburbs of Sydney. Patients with HIV infection who underwent surgical procedures at St. Vincent's hospital during the period 1990 to 1999 were retrospectively reviewed in order to describe the nature of the operative procedures required in the management of these patients. There were 636 patients with documented infection with HIV who underwent 889 surgical procedures at St. Vincent's hospital during the period 1990 to 1999. The number of procedures performed for patients with known HIV infection was increasing during this period. Patients with HIV infection accounted for 1.1% of all surgical procedures performed at this institution during this period. The proportion of total operative cases that patients with known HIV infection represented was seen to be increasing during this period. Surgical procedures were performed during only a small proportion of admissions of patients with HIV infection to St. Vincent's hospital for this period (2.4% of these admissions). The patients were predominantly males in younger age groups. Anorectal procedures for the local treatment of benign conditions were the most common procedures performed for these patients, followed by procedures for the insertion or removal of long-term vascular access devices and other minor general surgical procedures. A large proportion of procedures were performed as day surgery cases (30%). Only a small proportion of cases were for the management of traumatic conditions (3%). A large proportion of patients with HIV infection (26%) underwent more than one procedure during this period, with anorectal disorders a common cause of repeat surgical admission. The operative findings after 498 surgical procedures performed for 360 patients with documented HIV infection during the period 1995 to 1999 were retrospectively reviewed. The number of cases in which AIDS-defining conditions were encountered were recorded, and varied according to the types of procedures performed. Overall, seventy AIDS-defining conditions were found at operation during sixty-five procedures (13% of all procedures for patients with HIV infection). Non-Hodgkin's lymphoma was the most frequently encountered AIDS-defining disorder found at operation, accounting for 41% of such conditions. Kaposi's sarcoma was the next most frequently encountered condition, accounting for 20% of cases followed by cytomegalovirus infection (11%). Procedures in which AIDS-defining conditions were commonly encountered included neurosurgical procedures (20 of 36 procedures were for AIDS-defining conditions), particularly stereotactic brain biopsy. Lymph node excision biopsies had AIDS-defining pathologies seen in 18 of 26 cases, particularly non-Hodgkin's lymphoma. AIDS-defining conditions were diagnosed in only 4% of anorectal procedures, with anal squamous cell malignant lesions a far more frequently observed disorder (diagnosed in 11% of cases). The clinical details of all patients who met the clinical criteria for AIDS who underwent midline laparotomy at St. Vincent's hospital during the period 1987 to 1998 were retrospectively examined. Thirty patients with AIDS underwent thirty laparotomies during this period. AIDS-defining conditions were found at fourteen procedures (47%). Non-Hodgkin's lymphoma was found in eleven of these laparotomies, Kaposi's sarcoma in two and cytomegalovirus in one. In nine of the patients with AIDS-defining conditions, the post-operative diagnosis was different to that expected pre-operatively. Patients with AIDS-defining conditions found at laparotomy had significantly lower serum albumin concentrations and body weight compared with those with more conventional surgical diagnoses. There was no difference in CD4 T-lymphocyte counts, the number of patients with a history of AIDS-defining conditions or the duration of HIV infection between these two groups. Patients with AIDS-defining conditions diagnosed at laparotomy required significantly longer post-operative hospital stays compared to those with other causes, although there was no difference in the incidence of post-operative complications or deaths occurring in these two groups. There was a high number of patients with post-operative complications seen after laparotomy (thirty-two complications in twenty-one patients; 70% of all patients). Chest infections, systemic sepsis and wound infections were the most frequently encountered post-operative complications. Five deaths occurred within thirty days of operation (17% of patients), and were due to overwhelming systemic sepsis in four cases and from blood loss and coagulopathy in one. The number and the nature of the complications and deaths occurring in patients with AIDS undergoing laparotomy at St. Vincent's hospital is in keeping with previously published reports from other centres. The clinical details of patients with documented HIV infection who underwent biliary tract procedures at St. Vincent's hospital during the period 1989 to 1998 were retrospectively reviewed. Eighteen patients with HIV (fourteen of which met the clinical criteria for AIDS) underwent cholecystectomy; ten for cholecystitis secondary to gallstones, one for mucocoele of the gallbladder due to obstruction of the cystic duct by a gallstone and seven for acalculous cholecystitis. Biliary tract procedures accounted for 24% of all abdominal procedures during this period. Patients were mostly male and in a relatively young age range. Cytomegalovirus infection was found in five cases of acalculous cholecystitis, Cryptosporidia in five and Microsporidia in two. A significantly greater proportion of patients with acalculous cholecystitis had a history of AIDS, and these patients had lower CD4 T-lymphocyte counts, compared with those patients with cholelithiasis. There was no statistical difference in the length of hospital admission or number of complications occurring in these two groups. Patients who had cholecystectomy performed as an elective procedure (n=7) were compared with those who had this procedure performed during admission for acute cholecystitis (n=11), and had a significantly lower duration of post-operative hospital stay. There was no difference in the number of complications occurring in these two groups. Laparoscopic cholecystectomy was performed in eight patients, and was not associated with a significant difference in hospital admission duration or incidence of complications when compared with the ten patients who underwent open cholecystectomy. The medical records of all patients presenting to St. Vincent's hospital during the period 1994 to 1998 with major penetrating wounds (gunshot wounds and stab wounds to the trunk or neck) were retrospectively examined to determine the number of such patients with a documented history of infection with HIV or hepatitis C virus (HCV), or with risk factors for these infections. Of the 148 patients with major penetrating wounds who were managed at St. Vincent??s hospital during this period, 5.4% had documented infection HCV and 1.3% with HIV. Risk factors were documented in thirty-one individuals (21%), with injecting drug use the most commonly recorded (19%). Individuals infected with HIV represent a substantial workload for surgical specialists at St. Vincent's hospital. Surgical procedures were an uncommon cause of admission for patients with HIV infection, but were important in the diagnosis and management of many AIDS-associated conditions and were increasing in number. AIDS-defining conditions accounted for only a small proportion of operative interventions in patients with HIV infection. Surgical procedures required in the management of patients with HIV infection encompassed a broad range of surgical specialties and types of procedures. AIDS-associated opportunistic infections and malignancy were frequently the cause of abdominal procedures in patients with HIV and AIDS. The number of patients with known HIV infection who present for elective and emergency surgical procedures, as well as the high prevalence of documented HIV and HCV in patients with major penetrating wounds at St. Vincent's hospital, reinforces the need for all health care workers to practice strict universal precautions against body fluid exposure at all times.
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Voets, Natalie L. "Pre-surgical fMRI evaluation of patients with temporal lobe epilepsy." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427657.
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Pinto, Anna. "The psychological impact of surgical complications on patients and surgeons." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/12778.
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Adverse events constitute a significant challenge for healthcare organisations not only in terms of their prevention but also in terms of their after-effects on the injured patients and the staff involved. This PhD aims to investigate the psychological impact of surgical complications on patients and surgeons on the basis that the operating room is one of the highest risk areas for serious adverse events. Chapter 1 presents background literature on the aftermath of patient safety incidents both from the patients’ and the healthcare professionals’ perspectives and outlines the gaps of knowledge in this area. Chapter 2 sets the scene for surgical complications and presents the limited existing data on patients’ and surgeons’ experiences of surgical adverse events. Chapter 3 provides an overview of relevant theoretical frameworks for the investigation and discussion of the psychological impact of surgical complications on patients and surgeons. A systematic review of the literature on the psychosocial impact of surgical complications on patients follows in Chapter 4. Chapters 5 and 6 present two empirical studies on surgeons’ experiences of surgical complications. Chapter 5 reports an interview study with 27 surgeons which yielded a range of themes relevant to the personal and professional impact of complications on surgeons, the factors that affect their reactions, their coping, their perceptions of support as well as their perceptions of the institutional cultures in the aftermath of serious complications. Chapter 6 presents a cross-sectional survey study, which aims to quantify the psychological effects of serious surgical complications on surgeons and to identify their psychosocial correlates. Chapters 7 and 8 focus on patients’ experiences of surgical complications. A two time-points interview study with 17 surgical patients who experienced complications of various levels of severity is reported in Chapter 7. This study presents findings relevant to the psychosocial effects of surgical complications on patients, the factors that affect their reactions as well as issues of patient-surgeon communication around complications. Informed by the findings of the systematic review, the patient interview study and relevant literature, a longitudinal cohort study on the psychological impact of surgical complications on patients and the psychosocial predictors of this impact is presented in Chapter 8. Chapter 9 presents an online survey study with patient safety managers on the management of the aftermath of serious patient safety incidents in the NHS. This study investigates how the aftermath of patient safety incidents is managed by NHS organisations and describes the support that is typically available to patients and healthcare staff. Chapter 10 ends with an overview of the key findings from each study, their methodological limitations, directions for future research and implications for supporting surgeons and patients in the aftermath of surgical complications.
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Tkachyk, S. V. "Features of surgical treatment of patients with lower jaw fractures." Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17831.
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Mori, Candace Lynn. "Understanding the Experience of Osteoporosis Risk in Bariatric Surgical Patients." Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1573669680874186.
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Walker, Annette Clare, of Western Sydney Nepean University, and Faculty of Nursing and Health Studies. "Nurse and patient work: comfort and the medical-surgical patient." THESIS_FNHS_XXX_Walker_ A.xml, 1996. http://handle.uws.edu.au:8081/1959.7/286.
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This grounded theory study investigates the experiences and perceptions of comfort and discomfort of hospital patients admitted for medical-surgical conditions, with a focus on the post-accute stage of hospitalisation. In-depth post-discharge interviews were conducted with seventeen English speaking adults who had been admitted to nine Australian hospitals. A substantive theory of finding comfort and of managing discomfort was generated. Processes of self-talk (anticipating, interpreting, accepting, making allowances and maintaining perspective) and self-care (self-help and seeking help, which involved accommodating to the level and type of help available through deferring, avoiding, persisting or desisting) were used to find comfort and to manage discomfort. The study has implications for nursign practice, management, research and education. Existing practice in the areas of assessment, communication, individualised care planning and the management of discomfort need to be strengthened if nursing care is to make a difference for this category of patient. The study revealed that integrated caring by nurses perceived by informants as 'experts', contributed most to the experience of finding comfort and managing discomfort in this group of informantsDoctor of Philosophy (PhD)
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Braun, Lesley Anne, and lgbraun@bigpond net au. "Complementary Medicines in Hospitals - a Focus on Surgical Patients and Safety." RMIT University. Health Sciences, 2007. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080414.115624.
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This study aimed to determine how CMs used by surgical patients are managed in the hospital system by doctors and pharmacists and what patient and practitioner influences affect this management. Research design and method Five systematic reviews were conducted to investigate the peer-reviewed literature for information about Australians use of CM; overseas and Australian doctors and CM; surgical patients use of CM and safety information about CMs in surgery as a basis to design and conduct three surveys. Surveys of hospital doctors, pharmacists and surgical patients were used to obtain measurement of people's attitudes, perceptions, behaviours and usage of CMs. For healthcare practitioners, knowledge of complementary medicines (CMs), past training, current practice and interest in future practice of complementary therapies (CTs) and education was also investigated. Approximately 50% of surgical patients reported taking CMs in the 2 weeks prior to surgery and approximately 50% of these patients intended to continue use in hospital. The most commonly used CMs were: fish oil supplements, multivitamins, vitamin C and glucosamine supplements as well as some CMs considered to potentially increase bleeding risk or induce drug interactions. It was not uncommon for CMs to be used at the same time as prescription medicines. Most surgical patients in general self-prescribe their CMs or have them recommended by family and friends whereas medical practitioners were the main prescribers to cardiac surgery patients. Nearly 60% of patients using CMs in the 2 weeks prior to admission did not tell hospital staff about use. The main reason for non-disclosure was not being asked about use whereas fear of a negative response was rarely a concern. The most common sources of information surgery patients refer to were GPs, pharmacists and health food stores. Hospital doctors and pharmacists did not routinely refer to information sources about CMs safety. The majority of doctors and pharmacists did not routinely ask patients about CMs, or record usage information. They had little training and knowledge of the evidence of commonly used CMs and lacked confidence in dealing with CMs-related issues. Their attitude to CMs is moderately negative and many are wary of safety, efficacy and cost-effectiveness issues. The majority of practitioners considered some CTs as potentially useful, particularly acupuncture, massage and meditation whereas the medicinal CTs and chiropractic were considered potentially harmful. Most practitioners were interested in future education about CMs and CTs and some would consider practising CTs. Personal usage of CTs was low although there was substantial interest in receiving future treatment. Despite many strategically orientated initiatives developed in Australia to promote evidence based medicine (EBM) and quality use of medicines (QUM), it appears that CMs have been largely ignored and overlooked in the practice of Medicine and Pharmacy within the hospital system. Furthermore, it appears that in regards to CMs a 'don't ask, don't tell, don't know' culture exists within hospitals and that evidence based patient-centred care and concordance is not being achieved and potentially patient safety and wellbeing is being compromised.
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Graham, David Warwick. "Corpus callosotomy outcomes in paediatric patients." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17980.
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Corpus callosotomy is a palliative disconnective neurosurgical treatment that is typically employed for patients with medically refractory epilepsy characterised by injurious drop attacks. This thesis describes the 20 year experience with corpus callosotomy at Great Ormond Street Hospital for Children (GOSH) in London and the Children’s Hospital at Westmead (CHW) in Sydney. Between January 1995 and December 2015, 76 patients underwent corpus callosotomy at GOSH (n=47) and CHW (n=29); 55 patients met inclusion criteria. Patient records were analysed for changes in seizure type and frequency, changes in injuries, changes in use of antiepileptic drugs, and neurological and surgical complications. Rare or no drop attacks was analysed using Kaplan–Meier event-free survival curves using right-censoring of data. Multivariable regression analysis was used to assess the effect of clinical characteristics on outcome at last follow up. Median follow up was 36 months (interquartile range 34 months). Overall 26/55 patients (47.3%) had rare or no drop attacks at last follow up. Of the children who had drop attacks at last follow up, 26/29 of these patients (89.7%) had a return of drop attacks within 12 months of surgery. There were no significant predictors of developing drop attacks post-surgery. Neurological complications occurred in 11/55 operations (20.0%) and resolved within 6 weeks in all patients. Surgical complications occurred in 6/55 operations (10.9%), with only one major complication (hydrocephalus) and no deaths. Corpus callosotomy was a well-tolerated palliative procedure that was effective at reducing the severity of drop attacks in this case series. In patients for whom drop attacks return, they are likely to do so within 12 months of surgery. Several other case series and systematic reviews provide evidence to support the hypothesis that corpus callosotomy is a safe and effective palliative treatment for patients with medically refractory generalised seizures that is typically characterised by injurious drop attacks. But there is no strong evidence to demonstrate the validity of that hypothesis. A case study is presented to highlight some of the bioethical issues of corpus callosotomy in children. Parental resistance to epilepsy surgery is a well-known barrier to access for all epilepsy surgery. While earlier intervention has demonstrable benefits on quality of life, some parents find the prospect of disconnection syndrome challenging and resist corpus callosotomy. The case study is then used to frame issues relating to consent and the best interests of children undergoing corpus callosotomy, highlighting the shortcomings of the concept of autonomy.
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Morris, J. M. "Psychosocial considerations in the surgical management of early breast cancer patients." Thesis, University of Southampton, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380556.
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Costa-D'Sa, Fanny F. "Experiencing a first surgical consultation : patients' interaction in an outpatient clinic." Thesis, Sheffield Hallam University, 2007. http://shura.shu.ac.uk/3209/.
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Using a grounded theory approach, this study, sets out to explore and elicit the patients' experience during the initial surgical consultation in an outpatient clinic. Its purpose is to derive an analytical understanding of patients' enactment of their role through observation of surgeon/patient interactions, to describe and explain how patients perceive their role during consultation and generate a theoretical framework. It is unique in using `patient voices' as a means of substantiating theories and observations distilled from data collected. The research question posed was: - How do patients describe their experience of the first consultation with a surgeon?
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Closs, Susan José. "Surgical patients' experiences of sleep, night-time pain and analgesic provision." Thesis, University of Edinburgh, 1992. http://hdl.handle.net/1842/19632.
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This thesis examines the interactions between sleep and pain through three studies of surgical patients. The first survey examined 200 patients' experiences of sleep in hospital; the second study examined analgesic provision retrospectively for a sub-sample of 36 patients from the initial survey; and the third study concentrated on 100 patients' experiences of, and the relationships between, sleep, pain and analgesic provision. The first study indicated that the majority of patients felt that their sleep was worse in hospital than at home. Pain or discomfort were cited by 90% of patients as disturbing sleep at night. The frequency with which pain was reported as a cause of disrupted sleep prompted the next stage of work. Second, a retrospective examination of analgesic provision for a sub-sample of patients from the first study showed that analgesics were given approximately half as frequently during the night than during the day. It was also found that a mean of only 27% of the maximum doses of analgesics prescribed were actually given within the immediate post-operative period. In the third study, closer attention was paid to relationships between post-operative pain, sleep and analgesic provision. Pain was the most commonly reported cause of night-time sleep disturbance. Almost three-quarters of the sample reported that pain had interfered with sleep in some way. Virtually half of the patients felt that pain was worse at night. Many patients held strong beliefs about the relationships between pain and sleep. Over one-third of the patients felt that tiredness affected post-operative pain, for the most part making it worse. One-third felt that sleep reduced the intensity of the pain. Over three-quarters felt that sleep helped them to cope effectively with their pain and almost all believed that sleep had a positive effect on recovery. Patients received fewest doses of opioid analgesics during the night (as in the second study), while the majority of doses were given in the morning and evening. This circadian pattern of administration was not evident for non-opioid analgesics. Between one-fifth and one-quarter of the maximum possible amount of analgesics prescribed was actually given during the first two post-operative days. Overall, these studies underline that sleep and pain are inextricably linked and achieving adequate sleep and pain control presents particular problems for post-operative patients. It is recommended that the interactions between sleep and pain should be recognised by nurse practitioners, educators and researchers. Ways of improving night-time post-operative care are discussed with particular reference to the development of effective and efficient methods of assessing and controlling pain at night. Such advances in care might promote sleep and recovery from surgery.
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Taniguchi, Tomohiko. "Initial Surgical VersusConservative Strategies in Patients With Asymptomatic Severe Aortic Stenosis." 京都大学 (Kyoto University), 2017. http://hdl.handle.net/2433/225456.
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Bader, Kathryn E. "Transforming the pain experience of surgical patients through shared decision-making." Pullman, Wash. : Washington State University, 2009. http://www.dissertations.wsu.edu/Thesis/Spring2009/K_Bader_052909.pdf.
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Dillon, Christina H. "Incidence of bacterial infections in the blood of pediatric surgical patients." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12088.
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Thesis (M.A.)--Boston UniversityObjective: The bacterial bloodstream infections in the surgical patients after their procedures at Boston Children’s Hospital and potential risk factors have never been evaluated. The goal of this study is to determine potential risk factors and ascertain whether the current practices of the Department of Anesthesiology are effective in preventing the transmission of infection. Methods: We analyzed all Boston Children’s Hospital surgical patients from 2012 who had blood cultures drawn within 48 hours of being in the operating room. From this, we attempted to identify risk factors for the infections through multivariate logistic regression. We compared the infection rate at Boston Children’s Hospital to a national benchmark (10%) using a test of binomial proportions to determine if current practices are effective. Results: 35,451 patients underwent surgery at Boston Children’s Hospital in 2012. Out of 494 patients who had blood cultures drawn within 48 hours of surgery, 21 subsequently developed bloodstream infections. Age, gender, race, admission location, length of stay, and surgical procedure type were not predictive factors (p>0.05). American Society of Anesthesiology score prior to surgery may be a risk factor (p=0.041). The infection rate at Boston Children’s Hospital was significantly less that the national benchmark (p=0.00). Conclusion: Since the infection rate at Boston Children’s Hospital is significantly less than the national benchmark, no changes in practice by the Department of Anesthesiology are currently necessary. However, additional studies are required to verify this finding.
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Driskill, Karen. "An Educational Program to Reduce Surgical Site Infection in Vascular Patients." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6891.
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Surgical site infections (SSIs) are a leading cause of morbidity and mortality in the United States. Researchers have demonstrated the impact that SSIs have on the healthcare system and the need to improve patient outcomes. The purpose of this project was to develop an educational program for the 8-member nursing staff of an outpatient vascular surgical office to help reduce the occurrence of SSI rates for patients seen pre and postoperatively after a noted increase in SSI rates at this clinical setting. Guided by the Fitzpatrick model, a group of 6 health care providers comprising 3 surgeons and 3 nurse practitioners served as content experts to conduct formative evaluation during development of the educational program. Members of the surgical office nursing staff completed a questionnaire; results were analyzed using descriptive analysis. Findings indicated that 100% of nursing staff had no on-site work training on basic signs and symptoms of infection and infection control; 100% of staff were not confident in assessment of the surgical site and addressing patient issues; and at least 50% reported that they lacked knowledge of proper wound care including bathing, dressing changes, and expected symptoms for healing and/or complications postoperatively. Educational materials were designed to address these gaps. This project might benefit the surgical center nursing staff by providing education to help reduce surgical site infection in vascular patients, and bring about positive social change by improving quality of life and patient outcomes for the vascular surgery patient through a reduction in the occurrence of SSIs.
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Mingo, Alicia Y. "Smoking and Surgical Site Infection in Orthopedic Patients' Lower Extremity Arthroplasty." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6356.
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Cigarette smoking has been a public health concern for many years, and the possible impact of smoking on surgical site infection (SSI) has been studied broadly. However, a gap in understanding has persisted concerning whether there is an association between smoking tobacco and the development of SSI among patients who undergo lower extremity surgery, specifically total knee arthroplasty (TKA). The purpose of this study was to examine the association between smoking and lower extremity SSI. Andersen's behavioral model (BM) was used to understand the risk factors relevant to the interaction between smoking and SSI. Application of the BM categories of predisposing, enabling, need, and behavioral habits facilitated the discussion of surgical outcomes. A quantitative, cross-sectional approach was used to analyze data from a legacy registry of an east coast hospital. The research question addressed whether there was a relationship of the smoking status of three groups (i.e., smokers, nonsmokers, and previous smokers) and the variables in the BM categories (predisposing variables of age, gender, and body mass index [BMI]; enabling variable of health care insurance coverage; and need variables of health diagnoses, diabetes, hypertension, deficiency anemia, rheumatoid arthritis [RA]) to postoperative SSI. Multiple logistic regression test was used and no statistical association was found between smoking status and SSI; however, RA had a significant association with SSI. Positive social change may occur through the dissemination of new knowledge to reduce the financial burden of the prevalence of SSI through behavioral changes and improvements to health wellness.
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Barth, Elaine. "The effect of preoperative instruction time on anxiety levels in surgical patients." Virtual Press, 1996. http://liblink.bsu.edu/uhtbin/catkey/1020144.
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Preoperative instruction has been documented to benefit patients. With recent health care changes, most patients are now admitted to the hospital on the day of surgery. The optimal time for preoperative instruction requires re-examination. This study evaluated differences in anxiety levels of patients who received structured preoperative instruction prior to hospital admission and patients who received unstructured preoperative instruction after admission on the day of surgery.Roy's Adaptation Model guided this study. The state scale of the State-Trait Anxiety Inventory (STAI) measured anxiety in a convenience sample (n=40) admitted for same-day surgery. Participants in one group received structured preoperative instruction 1-7 days prior to surgery. Participants in a second group received unstructured preoperative instruction on the day of surgery. All participants completed the STAI 1-7 days before surgeryand on the morning of surgery. Paired t-tests on difference scores showed no significant difference in anxiety between the groups.School of Nursing
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Alexander, Beth. "The psychological impact of intensive care on non-emergency cardiac surgical patients /." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09HS/09hsa374.pdf.
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Buffone, Vincent. "Polymorphonuclear leukocyte functions and cell mediated immunity in surgical and trauma patients." Thesis, McGill University, 1985. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=63177.
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Ball, Jennifer. "Pressurized whey protein-based oral nutrition support promotes anabolism in surgical patients." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104817.
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The objective of the present thesis was to determine whether an oral nutrition support regimen based on pressurized whey protein isolate and glucose improves the postoperative utilization of amino acids compared to glucose alone. Patients undergoing colorectal surgery were randomly assigned to receive an oral nutrition support regimen based on pressurized whey protein isolate and glucose or glucose alone. Leucine kinetics, serum hormone and substrate concentrations, resting energy expenditure and substrate utilization were measured before surgery and two days after surgery. The baseline characteristics of the two groups were similar before surgery. Postoperative leucine balance increased in the fed state in both groups but the change in leucine balance was significantly greater in the whey protein-based group. Only the whey protein-based group achieved positive leucine (protein) balance, which was attributed to greater suppression of protein breakdown. Protein synthesis was not affected by feeding or by nutrition regimen. Serum glucose and insulin increased in the fed state but patients in both groups remained normoglycemic. Fasting cortisol, total protein and albumin decreased after surgery in both groups. Postoperative oxygen consumption, carbon dioxide production and respiratory quotient increased in both groups in the fed state; diet group did not affect the calorimetry parameters. Oral nutrition support based on pressurized whey protein isolate may help to avoid complications associated with postoperative body protein losses and hyperglycemia. Future research should focus on a direct comparison between oral and parenteral nutrition support and the functional clinical impact of minimizing perioperative fasting by implementing this oral nutrition regimen in the immediate perioperative period.L'objectif de la présente étude était à déterminer si un régime nutritif oral à base de protéines lactosérum traitée sous pression et glucose améliore l'utilisation post-opératif des acides aminées a comparé au glucose seul. Des patients subissant une intervention chirurgicale colorectale étaient assignés de façon aléatoire à recevoir un régime orale nutritif à base du glucose seul ou à base de protéines lactosérum traitées sous pression et glucose. Les paramètres suivants étaient quantifiées avant l'intervention et deux jours après l'intervention : cinétiques de leucine, la concentration des hormones et soustrait dans le sérum, la dépense d'énergie à la détente, et l'utilisation de la soustrait. Les deux groupes étaient homogènes avant l'intervention chirurgicale. La balance de leucine post-opérative a augmenté dans l'état nourrie pour les deux groupes, mais l'augmentation était plus grande dans le groupe nourri des protéines lactosérum. Seul le groupe nourri des protéines lactosérum a réussi une balance positive de leucine (des protéines), ce qui est attribuable à l'augmentation de la suppression de la destruction des protéines. La synthèse des protéines n'a pas été affectée par l'alimentation ou par le régime nutritif. Les niveaux de glucose et d'insuline dans le sérum ont augmente dans les deux groupes même si les deux groupes se trouvaient normoglycémiques. Les niveaux à jeun de cortisol, de protéines totales, et de l'albumen ont descendu après l'intervention chirurgicale dans les deux groupes. Les paramètres VO2, VCO2 et QR post-opératives ont augmenté dans les deux groupes à l'état nourri; le régime nutritif n'a pas affecté les paramètres calorimétriques. Un régime nutritif oral à base de protéines lactosérum traitées sous pression peut aider à éviter les complications associées à la perte des protéines corporelles ainsi que l'hyperglycémie suivant une intervention chirurgicale. Les recherches futures devraient cibler une comparaison directe entre la nutrition orale et parentérale, afin de minimiser la période de jeun en implémentant ce régime nutritif oral dans la période périopératoire.
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Mackenzie, Matthew Robert. "Understanding anesthesia's role in the unplanned admission of pediatric ambulatory surgical patients." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12496.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Introduction: Pediatric ambulatory surgery has experienced a surge in popularity as new surgical and anesthetic techniques have made it a more viable option for a host of surgical procedures. While the vast majority of patients are successfully discharged upon recovery from anesthesia, a small proportion 1-2.5% in previous studies must be admitted to the hospital's inpatient unit. Many of these patients present with conditions such as uncontrollable post-operative pain and nausea and vomiting associated with anesthesia. As such we sought to characterize the unplanned admissions population at Children's Hospital Boston, a tertiary care pediatric hospital and investigate Anesthesia's role in their care. Methods: Patients were identified as possible candidates for inclusion into this study if they experienced a status change in the Children's Hospital Boston records system from "Day Surgery Unit" to "Inpatient Unit". Data from these patients was gathered using Anesthesia records, medical record number summaries, growth charts, and other electronic medical records. Results: The unplanned admission rate at Children's Hospital Boston was 1.29% from January 2010 through June 2011, representing 347 patients from a day surgery population of 26,951. No statistically significant differences were observed in regards to patient fitness, as measured by American Association of Anesthesiologist classification, when compared to patients successfully discharged. The leading causes of admission were uncontrollable postoperative pain (n=117, 39.8%) and post-operative nausea and vomiting (n=94, 32.0%). When compared to the successfully discharged patient population; orthopedic surgery experienced a statistically significant increase in its contribution rate while genitourinary surgery experienced a statistically significant decrease. Pre-operative acetaminophen usage was only 19%, while midazolam pre-medication was 51.4%. Regional anesthesia was utilized in only 11.5% of cases overall and 27.3% of orthopedic patients. Patients experiencing post-operative nausea and vomiting were primarily treated with ondansetron and dexamethasone as prophylaxis while overwhelmingly receiving a re-dosing of ondansetron post operatively. Post-operative utilization of metaclopramide in these patients was 3.7%. Conclusion: At Children's Hospital Boston 71.8% of unplanned admissions are either for pain or nausea and vomiting, two conditions that are intimately related. It is reasonable to presume that an increased emphasis on prophylaxis analgesia in the form of pre-operative acetaminophen and regional anesthesia would help alleviate a portion of these cases directly related to uncontrollable pain. It is also not unreasonable to assume that these options may decrease post-operative opioid usage, a significant risk factor for post-operative nausea and vomiting. In cases where nausea and vomiting is still present and patients have received ondansetron and dexamethasone intraoperatively, there seems to be a reliance on re-dosing with ondansetron, whereas based on physiological pathways of nausea patients, a third drug-class may be a better option. Improvements in these areas could decrease the unplanned admission rate at Children's Hospital Boston.
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Kallam, Ramana Reddy. "Influence of gut function on SIRS and clinical outcomes in surgical patients." Thesis, University of Hull, 2012. http://hydra.hull.ac.uk/resources/hull:8007.
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Background: The GI tract is a highly complex organ system with multitude of functions. Gastrointestinal dysfunction remains an unrecognised clinical entity in day to day clinical practice hence it is possible many patients are inadequately managed resulting in poorer clinical outcomes. Recognising gut failure and early initiation of gut directed therapies may influence clinical outcomes. Aims: This thesis aims to review available literature for importance of gut function and its influence on SIRS and clinical outcomes and investigate the state of gut function and its influence on SIRS and clinical outcomes in surgical patients, further develop a method to optimise gut function and test the influence of this optimisation package on clinical outcomes in elective surgical patients. Methods: A series of clinical studies in elective surgical patients to investigate the influence of gut function on clinical outcomes. Results: Inadequate gut function was common in patients with pancreatitis and the persistent gut failure was associated with SIRS, MODS and poorer clinical outcomes. Critically ill patients with gut failure had increased prevalence of SIRS however this has not resulted in increased mortality or poorer clinical outcome. Elective GI surgical patients developed gut dysfunction in the post operative period more commonly than patients who underwent breast surgery and this was associated with increased prevalence of SIRS and septic morbidity. Optimisation of gut function was associated with early return of gut function and improved clinical outcomes in elective surgical patients. Conclusion: Recognition of gut failure is important in day to day clinical practice and gut failure is associated with poorer outcomes in surgical patients. Gut directed therapy to optimise gut function is associated with improved clinical outcomes.
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Siki, O. P. "Efficiency of surgical treatment of patients with diabetic foot syndrome in Nigeria." Thesis, Sumy State University, 2017. http://essuir.sumdu.edu.ua/handle/123456789/58602.
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Diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long term (chronic) complication of diabetes mellitus. Diabetic Foot syndrome exhibits several characteristic diabetic foot pathologies such as; diabetic foot ulcer and neuropathic osteoarthropathy which may require surgical intervention for correction.