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European Urology Focus Jan 2024Surgeons must adopt multidisciplinary, evidence-based approaches to preoperative care for radical cystectomy to optimize outcomes. Implementation of early recovery after...
Surgeons must adopt multidisciplinary, evidence-based approaches to preoperative care for radical cystectomy to optimize outcomes. Implementation of early recovery after surgery protocols and individualized prehabilitation plans is crucial for reducing perioperative risks and enhancing postoperative quality of life.
Topics: Humans; Quality of Life; Preoperative Exercise; Preoperative Care; Cystectomy; Postoperative Period
PubMed: 37872082
DOI: 10.1016/j.euf.2023.10.013 -
Anesthesiology Clinics Sep 2014Patients undergoing vascular surgery present a myriad of perioperative challenges due to the complex comorbidities affecting them in conjunction with high-risk surgical... (Review)
Review
Patients undergoing vascular surgery present a myriad of perioperative challenges due to the complex comorbidities affecting them in conjunction with high-risk surgical procedures. Additionally, advances in endovascular technology have enabled surgical procedures to be performed on patients who would not have been considered surgical candidates in the past. This combination of increasing patient morbidity and evolving surgical technique requires a well-planned preoperative assessment and close communication with surgical and perioperative colleagues. This article outlines an appropriate approach by first considering each organ system, followed by review of considerations unique to various surgical procedures, and then an overall assessment of risk.
Topics: Humans; Minimally Invasive Surgical Procedures; Preoperative Care; Vascular Surgical Procedures
PubMed: 25113723
DOI: 10.1016/j.anclin.2014.05.006 -
Current Opinion in Anaesthesiology Feb 2023Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of... (Review)
Review
PURPOSE OF REVIEW
Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management.
RECENT FINDINGS
Patients requiring thoracic surgeries present some of the most challenging cases for both intraoperative and postoperative management. The recent SARS-CoV-2 pandemic has only exacerbated these concerns. Effective preoperative optimization, however, provides for identification of patient comorbidities, allowing for mitigation of surgical risks. This kind of planning is multidisciplinary by nature. We believe patients benefit from early engagement of a dedicated preoperative clinic experienced for caring for complex surgical patients.
SUMMARY
Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.
Topics: Humans; Thoracic Surgery; COVID-19; SARS-CoV-2; Thoracic Surgical Procedures; Perioperative Care; Preoperative Care
PubMed: 36550607
DOI: 10.1097/ACO.0000000000001215 -
Joint Commission Journal on Quality and... May 2024Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician...
BACKGROUND
Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction.
METHODS
Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.
RESULTS
In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.
CONCLUSION
Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
Topics: Humans; Cross-Sectional Studies; Aged; Female; Male; Middle Aged; Preoperative Care; Communication; New England; Aged, 80 and over
PubMed: 38360446
DOI: 10.1016/j.jcjq.2024.01.006 -
Anesthesiology May 2016
Topics: Female; Humans; Male; Models, Theoretical; Monitoring, Intraoperative; Patient Admission; Postoperative Complications; Preoperative Care
PubMed: 27093662
DOI: 10.1097/ALN.0000000000001067 -
Critical Care Nursing Quarterly 2017The focus of this literature analysis is the concept of preparing the family and children for surgery. As posited in the literature, surgery causes stress and anxiety...
The focus of this literature analysis is the concept of preparing the family and children for surgery. As posited in the literature, surgery causes stress and anxiety that have a negative impact on both parents and their children. Therefore, the need for health care professionals to facilitate positive preparation for surgery to minimize anxiety and enhance postoperative recovery is important. Preparing the family and children for surgery is discussed in depth under the following themes: Preoperative Anxiety in Children, the Impact of Preoperative Anxiety on the Pediatric Patients and Parents, Preoperative Psychological Preparation for Children and Parents, and the Role of Nurse Practitioners in Preoperative Preparation. Through reviewing the literature, it would appear that some areas of preparation for parents are not as sufficient as they could be, particularly with regard to adequate preoperative education programs. The majority of studies reported that therapeutic play and clown interventions used for psychological preparation of parents and their children have been effective in minimizing and decreasing anxiety levels.
Topics: Ambulatory Surgical Procedures; Anxiety; Child; Humans; Parents; Pediatric Nurse Practitioners; Preoperative Care; Stress, Psychological
PubMed: 28240692
DOI: 10.1097/CNQ.0000000000000146 -
BMJ (Clinical Research Ed.) Aug 2017
Topics: Exercise Therapy; Humans; Preoperative Care; Recovery of Function
PubMed: 28790033
DOI: 10.1136/bmj.j3702 -
The American Surgeon Jul 2020
Topics: Authorship; Child; Child Welfare; Humans; Ophthalmologic Surgical Procedures; Ophthalmology; Personal Autonomy; Physician-Patient Relations; Preoperative Care; Professional-Family Relations; Television; Trust
PubMed: 32916071
DOI: 10.1177/0003134820918259 -
Anesthesia and Analgesia Feb 2018Over the past decade, evolutionarily conserved, noncoding small RNAs-so-called microRNAs (miRNAs)-have emerged as important regulators of virtually all cellular... (Review)
Review
Over the past decade, evolutionarily conserved, noncoding small RNAs-so-called microRNAs (miRNAs)-have emerged as important regulators of virtually all cellular processes. miRNAs influence gene expression by binding to the 3'-untranslated region of protein-coding RNA, leading to its degradation and translational repression. In medicine, miRNAs have been revealed as novel, highly promising biomarkers and as attractive tools and targets for novel therapeutic approaches. miRNAs are currently entering the field of perioperative medicine, and they may open up new perspectives in anesthesia, critical care, and pain medicine. In this review, we provide an overview of the biology of miRNAs and their potential role in human disease. We highlight current paradigms of miRNA-mediated effects in perioperative medicine and provide a survey of miRNA biomarkers in the field known so far. Finally, we provide a perspective on miRNA-based therapeutic opportunities and perspectives.
Topics: Anesthesiology; Biomarkers; Humans; MicroRNAs; Preoperative Care
PubMed: 28922229
DOI: 10.1213/ANE.0000000000002444 -
Journal of Clinical Nursing Jul 2017To explore the issues and challenges of care transitions in the preoperative environment.
AIMS AND OBJECTIVES
To explore the issues and challenges of care transitions in the preoperative environment.
BACKGROUND
Ineffective transitions play a role in a majority of serious medical errors. There is a paucity of research related to the preoperative arena and the multiple inherent transitions in care that occur there.
DESIGN
Qualitative descriptive design was used.
METHODS
Semistructured interviews were conducted in a 975-bed academic medical centre.
RESULTS
A total of 30 providers and 10 preoperative patients participated. Themes that arose were as follows: (1) need for clarity of purpose of preoperative care, (2) care coordination, (3) interprofessional boundaries of care and (4) inadequate time and resources.
CONCLUSION
Effective transitions in the preoperative environment require that providers bridge scope of practice barriers to promote good teamwork. Preoperative care that is a product of well-informed providers and patients can improve the entire perioperative care process and potentially influence postoperative patient outcomes.
RELEVANCE TO CLINICAL PRACTICE
Nurses are well positioned to bridge the gaps within transitions of care and accordingly affect health outcomes.
Topics: Academic Medical Centers; Adult; Female; Humans; Patient Care Team; Perioperative Care; Preoperative Care; Qualitative Research; Quality of Health Care; Time Factors; Transitional Care
PubMed: 27706872
DOI: 10.1111/jocn.13610