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Advances in laparoscopy for acute care surgery and trauma

World Journal of Gastroenterology 2016年第2期22卷 668-680页

作者： Matteo Mandrioli Kenji Inaba Alice Piccinini Andrea Biscardi Massimo Sartelli Ferdinando Agresta Fausto Catena Roberto Cirocchi Elio Jovine Gregorio Tugnoli Salomone Di Saverio Department of Emergency and General Surgery and Trauma Surgery Unit C.A.Pizzardi Maggiore Hospital Trauma Center40133 BolognaItaly Division of Trauma Surgery and Surgical Critical care Department of SurgeryUniversity of Southern CaliforniaLos AngelesCA 90033United States Department of Surgery Macerata Hospital62100 MacerataItaly Department of Surgery Adria Hospital45011 AdriaRovigoItaly Department of Emergency and Trauma Surgery Maggiore Hospital43126 ParmaItaly Departement of Digestive Surgery and Liver Unit St.Maria Hospital05100 TerniPerugiaItaly

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers,for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a la

关键词： Laparoscopy Acute care surgery Singleincisionlaparoscopic surgery Natural orifice transluminalendoscopic surgery Trauma

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Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer

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World Journal of Gastroenterology 2015年第47期21卷 13294-13301页

作者： Johanna Mrena Anne Mattila Jan B?hm Ismo Jantunen Ilmo Kellokumpu Department of Surgery Central Hospital of Central Finland Department of Pathology Central Hospital of Central Finland Department of Oncology Central Hospital of Central Finland

AIM: To examine the quality of surgical care and longterm oncologic outcome after D2 gastrectomy for gastric ***: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followedup for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national ***: A total of 109 patients(58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stageⅠ,(27/109) 24.8%; stage Ⅱ,(31/109) 28.4%; stage Ⅲ,(41/109) 37.6%; and stage Ⅳ,(10/109) 9.2%. Forty patients(36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival(both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival(all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical(including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, ***: D2 dissection is a safe surgical option for gastric cancer, providing quality

关键词： Gastric cancer Quality of care Survival Gastric surgery Clinical practice

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care and Support Programmes for Orphans and Vulnerable Children: Achievements and Implications of HIV/AIDS Funded Project in Osun State, Nigeria

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World Journal of AIDS 2019年第4期9卷 195-213页

作者： Adebola A. Adejimi Ajibola Olagunoye Adeyemi Amuda Olubukola Alawale Oluwatoyin Adeola-Musa Abayomi Adenekan Akin Oyebade Mosur Bello Michael Olugbile Olusegun Adeoye Gabriel Olatunji Department of Community Medicine Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital Osogbo Osun State Nigeria Department of Community Medicine University of Ibadan Ibadan Nigeria Department of Epidemiology and Disease Control Osun State Ministry of Health Osogbo Osun State Nigeria Osun State Agency for the Control of AIDS Osogbo Nigeria HIV Programme Development Project (HPDP2) World Bank Abuja Nigeria.

Orphans and Vulnerable Children (OVC) and their families face many challenges but there are opportunities to provide care and support programmes for them in their communities. This paper presents the achievements and implications of HIV Programme Development Project (HPDP) funded by World Bank on care and support services for OVC in Osun State, Nigeria. Eight Civil Society Organisations (CSOs) were engaged by Osun State Agency for the Control of AIDS (OSACA) as part of HPDP to provide care and support services for OVC between year 2013 and 2015. Using reporting tools, data collected by the CSOs were entered into District Health Information System 2 (DHIS2) platform and analysed using Microsoft Excel. In addition, Key Informant Interviews (KII) were conducted among the selected CSOs, OVC and the caregivers who were beneficiaries of HPDP in Osun State, Nigeria. A total of 12,353 OVC were reached and about half of them were female. There was an increase in the trends of number of OVC seen and the support services provided from the year 2013 to 2015. Of the 12,353 OVC that benefitted from this programme, 1905 (15.4%) received health care services, 5383 (43.6%) received nutritional services, 5317 (43.0%) received educational services and 9861 (79.8%) were provided with psychosocial support services. About 503 (4.1%) of the OVC received economic strengthening services while 270 (2.2%) of household heads were provided with economic support. However, 3 OVC were lost to follow-up, 14 OVC voluntarily withdrew from the project and 6 OVC died. The FGD and KII revealed that the project was very impactful in transforming the lives of the OVC. Programmes for children orphaned and made vulnerable by HIV/AIDS will contribute to the achievement of HIV/ AIDS prevention and control efforts. The HIV/AIDS free generation can be built by responding to the physical, social and mental needs of these children and their families in their communities. There is a need to scale-up this programme

关键词： HIV Orphans Vulnerable Children HPDP care and Support Nigeria

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care Taking of Obstetric Emergencies in the Department of Gynaecology and Obstetrics at Donka National Hospital, University Teaching Hospital (CHU) of Conakry, Guinea

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Open Journal of Obstetrics and Gynecology 2019年第5期9卷 604-611页

作者： Boubacar Siddi Diallo Ibrahima Sory Balde Ibrahima Conte Mamadou Hady Diallo Ousmane Balde Ibrahima Sylla Abdourahmane Diallo Oumou Hawa Bah Fatoumata Binta Sow Telly Sy Yolande Hyjazi Namory Keita University Department of Gynecology-Obstetrics Donka National Hospital Conakry Guinea University Department of Gynecology-Obstetrics Ignace Deen National Hospital Conakry Guinea

Objectives: The objectives of this work were to calculate the frequency of obstetrical emergencies, to describe the socio-demographic profile of women admitted for obstetric emergencies, to identify the main emergencies, to describe the care taking of emergencies and to establish the maternal foetal prognosis of obstetric emergencies. Methodology: It was a 6-month descriptive prospective study conducted in the Obstetrics and Gynaecology Department of the Donka National Hospital, CHU Conakry, Guinea. The study took place from July 1st to December 31st, 2005. The data collected were entered and corrected using the Word and Excel 2010 software and then transferred to the Epi Info software version 7 for analysis. The results are presented in the form of tables, figures and texts using Word and Excel software, commented on, discussed and compared to current literature data. The limitations of the study: The poor filling of the partograph has been the main problem of our study. Results: The frequency of obstetric emergencies was 19% in the Department. The socio-demographic profile was that of a woman aged 15 to 24 (46.4%), married (92%), housewives (38.1%), out of school (49.5%), nulliparous (34.3%), without prenatal follow-up (47.37%), coming from home (56%), evacuated (44%). The main emergencies are dominated by haemorrhage (34.5%) followed by HTA Arterial hypertension and eclampsia (25.7%). The therapeutic attitude was based on clinical data and was dominated by caesarean section (70%). General anaesthesia was performed in 75% of cases and 1.6% benefited from local anaesthesia. The demand for blood was honoured in 19% of the cases. The maternal morbidity was dominated by anaemia (66.7%) and a lethality of 4%. After the 5th minute, 47% of the newborns had APGAR greater than 7. The neonatal mortality rate was 21%. Conclusion: To avoid and/or reduce obstetric emergencies, it is necessary to detect and treat risk factors during referrals, properly monitor child labor, refu

关键词： Obstetric Emergency care Taking

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Infection management strategy based on prevention and control of nosocomial infections in intensive care units

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Chinese Medical Journal 2019年第1期132卷 115-119页

作者： Long-Xiang Su Xiao-Ting Wang Pan Pan Wen-Zhao Chai Da-Wei Liu Department of Critical care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China Department of Critical care Medicine Beijing Tiantan HospitalCapital Medical UniversityBeijing 100071China

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection,which is clinical problem often faced by intensive care units (ICU) *** positive treatment,the incidence and mortality of sepsis are high.^[1]As hospital infection control plays an essential role in treating the nosocomial infections in the ICU,and according to the clinical presentation of critically ill patients,the biological characteristics of pathogenic microorganisms and the ICU environment,this article put forward a strategy for the nosocomial infections in the ICU.

关键词： nosocomial infections intensive care units prevention control

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Prevention and Reduction of Complications in Women with Vulvar Cancer: Development of an Algorithm for Safer Multidisciplinary care

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Journal of Cancer Therapy 2015年第10期6卷 821-832页

作者： Beate Senn Andrea Kobleder Silvia Raphaelis Michael D. Mueller Beatrice Kammermann Kathryn White Manuela Eicher Institute for Applied Nursing Sciences IPW-FHS St. Gallen Switzerland Sydney Nursing School The University of Sydney Sydney Australia Department of Nursing Science Vienna Austria Department of Obstetrics and Gynecology Berne Switzerland School of Health Sciences University of Applied Arts and Sciences Western Switzerland Fribourg Switzerland

Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.

关键词： Vulvar Cancer Post-Surgical Complications care Algorithm Health care Professionals

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Safety and Quality of care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

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Open Journal of Nursing 2020年第2期10卷 131-142页

作者： Sayuri Kaneko Department of Nursing Administration and Nursing Education Nagano College of Nursing Nagano Japan

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

关键词： Activity Condition Cognitive Function Long-Term care Facility Safety Quality of care

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A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

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Open Journal of Nursing 2012年第1期2卷 8-14页

作者： Alysha Visram Donna Wilson Center for Health Promotion Studies School of Public Health University of Alberta Edmonton Canada Faculty of Nursing University of Alberta Edmonton Canada

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

关键词： Polypharmacy Drug Interactions Older People Aging Nursing Homes Continuing care Comparative Research

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Quality of Antenatal care: Comparison between Secondary and Tertiary Health Facilities in Ibadan, Nigeria

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Open Journal of Obstetrics and Gynecology 2018年第6期8卷 559-571页

作者： Oluwasomidoyin Olukemi Bello Department of Obstetrics and Gynaecology University College Hospital Ibadan Oyo State Nigeria

Background: Patient satisfaction is related to the quality of services received and the extent to which specific needs are met. Satisfied patients are likely to come back for the health services and recommend it to others. Objective: To assess and compare patients’ satisfaction with the quality of prenatal/antenatal care (QPC) services received at a tertiary and secondary health facility in Ibadan, Nigeria. Methods: A comparative cross sectional study used an interviewer administered questionnaire to assess and compare the quality of antenatal care among women who had antenatal care and delivered live baby in two government health facilities—Adeoyo Maternity Hospital (secondary health facility) and University College Hospital (tertiary health facility). A total of 500 women were interviewed within 48 hours post delivery and data obtained was analyzed with SPSS version 20. Results: The mean age was 29.7 (SD = 4.95) years. About half of the respondents had more than four antenatal visits, almost two-thirds (61.4%) were primipara, and 55.6% delivered per vagina. Almost all (98.4%) the women were very satisfied with the QPC received while a little above half (54.0%) received high QPC. Health facility and mode of delivery were found to be significantly associated with the satisfaction of the QPC. Factors predicting high QPC comparing the tertiary and secondary health facility are “availability” (OR = 0.341, 95%CI = 0.173 - 0.672) and “support and respect” (OR = 5.599, 95%CI = 3.621 - 8.659) of health care workers. Conclusion: Though the women were very satisfied with the QPC rendered barely half of them reported high quality QPC and this should be the ultimate aim. Promoting and ensuring high quality of antenatal care in our hospitals will improve the antenatal attendance and hospital deliveries with subsequent reduction in maternal morbidity and mortality.

关键词： Quality Antenatal care Satisfaction

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Implement the Palliative care in Medical Practice of a Tertiary Comprehensive Hospital in China

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Chinese Medical Sciences Journal 2018年第4期33卷 210-215页

作者： Xiaohong Ning Department of Geriatrics Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing100730China

The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based *** concept of palliative care hasn't been fully applied to medical practice by care providers in China's Mainland,where the seriously ill or terminal patients mainly receive medical care in *** implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and *** article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this *** hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment.

关键词： palliative care medical practice education team building

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