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Pakistan needs to speed up its human immunodeficiency virus control strategy to achieve targets in fast-track acquired immune deficiency syndrome response

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World Journal of Virology 2017年第2期6卷 46-48页

作者： Yasir Waheed Hasnain Waheed Foundation University Medical College Foundation University Islamabad Bridging Health Foundation

In last fifteen years remarkable success in the fight against human immunodeficiency virus(HIV) is achieved globally. The number of HIV infections has decreased and the number of people on antiretroviral therapy is increased. This all is possible by strong political commitments and heavy investments in the fight against HIV. Pakistan is among few Asian countries in which HIV cases are increasing year by year since 1990. There are 94000 cases of HIV in Pakistan and only 14000 are registered with government. The main source of HIV infection in Pakistan is the use of contaminated injection equipment among people who inject drugs(PWID). The overall prevalence of HIV among PWID in Pakistan is 27.2%. There are five cities in Pakistan in which HIV prevalence is above 40% in PWIDs. In June 2016, United Nations political declaration on acquired immune deficiency syndrome(AIDS) provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. To achieve the targets in fasttrack AIDS response, the global leaders showed strong commitments to invest $ 26 billion per year by 2020. Pakistan needs to speed up its HIV control program. There is a dire need to locate all HIV positive people and enroll them in the treatment program. Pakistan also needs to calculate exact number of people living with HIV, increase HIV treatment centers and increase HIV awareness. Recently, Global Fund invested handsome money in the fight against HIV. Let's hope the country will have effective HIV control strategy to achieve the HIV elimination target by 2030.

关键词： Human immunodeficiency virus People who inject drugs fast-track Antiretroviral therapy

fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

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World Journal of Gastroenterology 2013年第47期19卷 9119-9126页

作者： Ping Li Fang Fang Jia-Xun Cai Dong Tang Qing-Guo Li Dao-Rong Wang Department of Gastrointestinal Surgery Subei People’s Hospital of Jiangsu Province the First Affiliated Hospital of Yang Zhou University Department of Colorectal Surgery Cancer Hospital Fudan University Department of Oncology Shanghai Medical CollegeFudan University

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

关键词： Laparoscopic surgery fast-track rehabilitation Enhanced recovery Colorectal surgery Complications Readmission

fast-track program vs traditional care in surgery for gastric cancer

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World Journal of Gastroenterology 2014年第2期20卷 578-583页

作者： Zhi-Xing Chen Ae-Huey Jennifer Liu Ying Cen Department of Burns and Plastic Surgery West China HospitalSichuan University

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surge

关键词： fast-track program Traditional care Gastric cancer

fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

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World Journal of Gastroenterology 2013年第23期19卷 3642-3648页

作者： Fan Feng Gang Ji Ji-Peng Li Xiao-Hua Li Hai Shi Zheng-Wei Zhao Guo-Sheng Wu Xiao-Nan Liu Qing-Chuan Zhao Department of Digestive Surgery Xijing Hospital of Digestive Diseases the Fourth Military Medical University

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

关键词： fast-track surgery Gastric cancer Radical total gastrectomy Perioperative care Outcomes

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

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World Journal of Gastroenterology 2014年第41期20卷 15423-15439页

作者： Liu-Hua Wang Chun-Ming Lu Fang Fang Dao-Rong Wang Ping Li Yan Wang Department of General Surgery Yizheng People’s Hospital Department of General Surgery Armed Police Corps Hospital of Jiangsu Department of Gastrointestinal Surgery Subei People’s Hospital of Jiangsu Province the First Affiliated Hospital of Yang Zhou University

AIM:To compare the safety of fast-track rehabilitation protocols(FT) and conventional care strategies(CC),or FT and laparoscopic surgery(LFT) and FT and open surgery(OFT) after gastrointestinal surgery.METHODS:We searched MEDLINE,WHO International Trial Register,Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials(RCTs) comparing FT and CC or comparing LFT and OFT,with 10 or more randomized participants and about 30 d follow-up.Two reviewers independently extracted data on complications,anastomotic leak,obstruction,wound infection,re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.RESULTS:Twenty-four RCTs of FT vs CC or LFT vs OFT were included.Compared with CC,FT reduced overall complications and wound infection.However,anastomotic leak,obstruction and re-admission were not significantly reduced.The pooled risk ratio(RR) of 0.69(95%CI:0.60-0.78; P 0.05),a pooled RR of 0.87(95%CI:0.67-1.15; P > 0.05) and pooled RR of 0.94(95%CI:0.73-1.22; P > 0.05) respectively.Compared with OFT,LFT reduced complications,with a pooled RR of 0.66(95%CI:0.54-0.81; P < 0.001).CONCLUSION:FTs are safe after gastrointestinal surgery.Additional large,prospective RCTs should be conducted to establish further the safety of this approach.

关键词： fast-track rehabilitation protocols Lapa-roscopic

Implementation of a nurse-led protocol for early extubation after cardiac surgery: A pilot study

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World Journal of Critical Care Medicine 2019年第3期8卷 28-35页

作者： Giovanni Serena Carlos Corredor Nick Fletcher Filippo Sanfilippo Cardiothoracic Intensive Care Unit Intensive Care Directorate-St Georges Healthcare NHS Foundation Trust

BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implemented in post-anaesthesia care units.Introducing a nurse-led extubation protocol may lead to reduced extubation time.AIM To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery,aiming at higher extubation rates by the third postoperative hour.METHODS A single centre prospective study in an 18-bed,consultant-led Cardiothoracic ICU,with a 1:1 nurse-to-patient ratio.During a 3-wk period,the protocol was implemented with:(1)Structured teaching sessions at nurse handover and at bed-space(all staff received teaching,over 90%were exposed at least twice;(2)Email;and(3)Laminated sheets at bed-space.We compared“standard practice”and“intervention”periods before and after the protocol implementation,measuring extubation rates at several time-points from the third until the 24th postoperative hour.RESULTS Of 122 cardiac surgery patients admitted to ICU,13 were excluded as early weaning was considered unsafe.Therefore,109 patients were included,54 in the standard and 55 in the intervention period.Types of surgical interventions and baseline left ventricular function were similar between groups.From the third to the 12th post-operative hour,the intervention group displayed a higher proportion of patients extubated compared to the standard group.However,results were significant only at the sixth hour(58%vs 37%,P=0.04),and not different at the third hour(13%vs 6%,P=0.33).From the 12th post-operative hour time-point onward,extubation rates became almost identical between groups(83%in standard vs 83%in intervention period).CONCLUSION The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.

关键词： fast-track Extubation protocol Intensive care Mechanical ventilation Implementation strategies

Early rehabilitation programs after laparoscopic colorectal surgery:Evidence and criticism

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World Journal of Gastroenterology 2013年第46期19卷 8543-8551页

作者： Duck-Woo Kim Sung-Bum Kang Soo-Young Lee Heung-Kwon Oh Myung-Hoon In Department of Surgery Seoul National University Bundang Hospital

During the past several decades,early rehabilitation programs for the care of patients with colorectal surgery have gained popularity.Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection.Patients cared for based on these protocols had a rapid recovery of bowel movement,shortened length of hospital stay,and fewer complications compared with traditional care programs.However,most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection.Currently,limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection,although this procedure seems to be associated with a higher morbidity than that reported with traditional care.In this article,we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery.We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies.We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery,focusing on laparoscopic resection.

关键词： Colorectal cancer Enhanced recovery after surgery Early rehabilitation fast-track Laparoscopy Rectal

Introducing an enhanced recovery after surgery program in colorectal surgery:A single center experience

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World Journal of Gastroenterology 2014年第46期20卷 17578-17587页

作者： Stefano Bona Mattia Molteni Riccardo Rosati Ugo Elmore Pietro Bagnoli Roberta Monzani Monica Caravaca Marco Montorsi Department of General Surgery University of Milan School of MedicineHumanitas Research Hospital20089 RozzanoMilanItaly

AIM:To study the implementation of an enhanced recovery after surgery(ERAS)program at a large University Hospital from"pilot study"to"standard of care".METHODS:The study was designed as a prospective single centre cohort study.A prospective evaluation of compliance to a protocol based on full application of all ERAS principles,through the progressive steps of its implementation,was performed.Results achieved in the initial pilot study conducted by a dedicated team(n=47)were compared to those achieved in the shared protocol phase(n=143)three years later.Outcomes were length of postoperative hospital stay,readmission rate,compliance to the protocol and morbidity.Primary endpoint was the description of the results and the identification of critical issues of large scale implementation of an ERAS program in colorectal surgery emerged in the experience of a single center.Secondary endpoint was the identification of interventions that have been proven to be effective for facilitating the transition from traditional care pathways to a multimodal management protocol according to ERAS principles in colorectal surgery at a single center.RESULTS:During the initial pilot study(March 2009 to December 2010;47 patients)conducted by a dedicated multidisciplinary team,compliance to the items of ERAS protocol was 93%,with a median length of hospital stay(LOS)of 3 d.Early anastomotic fistulas were observed in 2 cases(4.2%),which required reoperation(Clavien-Dindo gradeⅢb).None of the patients had been discharged before the onset of the complication,which could therefore receive prompt treatment.There were also four(8.5%)minor complications(ClavienDindo gradeⅡ).Thirty days readmission rate was 4%.Perioperative mortality was nil.After implementation of the protocol throughout the Hospital in unselected patients(May 2012 to December 2012;147 patients)compliance was 74%,with a median LOS of 6 d.Early anastomotic fistulas were observed in 11 cases(7.7%),5(3.5%)of which required reoperation(Clavien-Dindo gradeⅢb).Two early anastomotic fi

关键词： Enhanced recovery after surgery fast-track surgery

Are “Straight to Test” Pathways Always Best for Patients? A Prospective Observational Study of Two-Week-Wait Colorectal Referrals

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Surgical Science 2013年第10期4卷 443-447页

作者： Frances Mosley Jon R. Ausobsky John P. Griffith Bradford Royal Infirmary Bradford UK Yorkshire and the Humber Deanery Bradford UK

Aim: Many centres have adopted a straight to test approach to deliver a fast-track service for suspected lower GI cancer. We undertook a prospective comparison between patients having a straight to test (STT) flexible sigmoidoscopy and those attending an outpatient appointment (OPA). The study aimed to determine whether STT reduced diagnostic time without additional investigations. Methods: An observational study of 200 consecutive fast-track colorectal referrals was undertaken. Data collected included: patient demographics, whether STT or OPA, investigations undertaken (including dates) and final diagnosis. Outcomes were compared by adjusted linear regression and logistic regression, for numerical and binary outcomes respectively. Potential confounding factors included were: age, gender and whether NICE referral criteria were achieved. Results: 186 out of 200 referrals attended their appointment, 62% (116/186) went STT and 38% (70/186) had an OPA. No significant difference was seen in the number of days to final investigation, adjusted coefficient -3.71, 95% C.I. -8.92 to 1.50. The STT group had 0.4 more tests per patient, adjusted 95% C.I. 0.07 to 0.73, than the OPA group. Significantly more patients in the STT group had a flexible sigmoidoscopy in addition to whole colonic imaging (all modalities), compared to the OPA group, adjusted OR of 93.47 (95% C.I. 29.26 to 298.54). Conclusion: This study highlights the potential disadvantages of STT flexible sigmoidoscopy for patients referred under the two-week-rule with suspected lower GI cancer. Despite the previously published work highlighting the potential cost and time benefits, it may come at the sacrifice of exposing patients to additional investigations.

关键词： Colorectal Neoplasms (MeSH) Endoscopy Gastrointestinal (MeSH) Colorectal Surgery (MeSH) 2-Week-Wait fast-track Straight to Test (No MeSH Term)