Chewing Gum Versus Standard Care for Enhanced Bowel Recovery After Cesarean Section: A Randomized Clinical Trial.

Background and objective Cesarean sections (CS) are common and occasionally critical surgical procedures. Nausea, vomiting, and postoperative ileus (POI) frequently occur in patients undergoing cesarean delivery with regional anesthesia. These issues affect patient comfort, slow down wound healing, and prolong hospital stays. Studies have employed various strategies to address these challenges. Chewing gum post-surgery is a cost-effective approach to stimulate intestinal movement, promoting early initiation of oral intake, early mobilization, shorter hospital stays, and reduced overall hospitalization time. In this study, we aimed to investigate the potential benefits of chewing gum in this patient population. Methodology We randomly assigned a total of 314 women scheduled for elective or emergency lower segment CS (LSCS) to either a gum-chewing group (Group A, n=157) or a control group receiving standard postoperative care (Group B, n=157). Participants in the gum-chewing group chewed sugar-free gum for one hour postoperatively in sessions lasting 15 minutes each, continuing until bowel sounds resumed, and were allowed to have oral sips of water. In contrast, the control group's bowel sounds were checked every half hour till they appeared, and women were allowed to have sips of water once the bowel sounds were heard. The primary comparisons between the groups focused on the timing of first bowel sounds, first passage of flatus, and first bowel movement. Secondary endpoints included time to mobilization, removal of the catheter, and subjective sense of well-being. Results The average age of women in both groups was 24 years. There were no statistically significant differences between the study and control groups concerning age, parity, occupation, type of CS, reasons for CS, skin incision, or intraperitoneal adhesions. In Group A, the mean time for bowel sounds to appear was 3.39 hours, compared to 6.91 hours in Group B. For flatus passage, the mean time was 12.74 hours in Group A and 20.51 hours in Group B. Stool passage took an average of 41.59 hours in Group A and 64.03 hours in Group B. Conclusions Chewing gum, a type of simulated eating, is linked to faster restoration of gastrointestinal function following CS. This study elucidates the mechanisms behind the benefits of chewing gum and explores its potential in diverse surgical populations. Ultimately, integrating chewing gum into postoperative care may offer a valuable tool for enhancing patient outcomes and accelerating recovery, provided it is used in conjunction with comprehensive and personalized postoperative care strategies. It is a cost-effective approach that accelerates the recovery of intestinal movement post-surgery, decreasing the length of hospital stay and overall burden on patients.

Prevalence of relevant early complications during the first 24 h on a normal ward in patients following PACU care after medium and major surgery: a monocentric retrospective observational study.

PURPOSE: Even today, it remains a challenge for healthcare professionals to decide whether a clinically stable patient who is recovering from uncomplicated medium or major surgery would benefit from a postoperative intensive care unit (ICU) admission, or whether they would be at least as adequately cared for by a few hours of monitoring in the post-operative care unit (PACU). METHODS: In this monocentric retrospective observational study, all adult patients who (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Anästh Intensivmed (50):S486-S489, 2009) underwent medium or major surgery between 1 January 1 2014 and 31 December 2018 at the Heidelberg University Surgical Center, and (Vimlati et al. in Eur J Anaesthesiol September 26(9):715-721, 2009) were monitored for 1-12 h in the PACU, and then (De Pietri et al. in World J Gastroenterol 20(9):2304-23207, 2014) transferred to a normal ward (NW) immediately thereafter were included. At the end of the PACU stay, each patient was cleared by both a surgeon and an anesthesiologist to be transferred to a NW. The first objective of this study was to determine the prevalence of relevant early complications (RECs) within the first 24 h on a normal ward. The secondary objective was to determine the prevalence of RECs in the subgroup of included patients who underwent partial pancreaticoduodenectomy. RESULTS: A total of 10,273 patients were included in this study. The prevalence of RECs was 0.50% (confidence interval [CI] 0.40-0.60%), with the median length of stay in the PACU before the patient's first transfer to a NW being 285 min (interquartile range 210-360 min). In the subgroup of patients who underwent partial pancreaticoduodenectomy (n = 740), REC prevalence was 1.1% (CI = 0.55-2.12%). CONCLUSION: Based on a medical case-by-case assessment, it is possible to select patients who after a PACU stay of only up to 12 h have a low risk of emergency readmission to an ICU within the 24 h following the transfer to the NW. Continued research will be needed to further improve transfer decisions in such low-risk subgroups.

Establishing Benchmarks for Airway Replacement: Long-Term Outcomes of Tracheal Autografts in a Large Animal Model.

OBJECTIVE: Airway replacement is a challenging surgical intervention and remains an unmet clinical need. Due to the risk of airway stenosis, anastomotic separation, poor vascularization, and necrosis, it is necessary to establish the gold-standard outcomes of tracheal replacement. In this study, we use a large animal autograft model to assess long-term outcomes following tracheal replacement. METHODS: Four New Zealand White rabbits underwent tracheal autograft surgery and were observed for 6 months. Clinical and radiographic surveillance were recorded, and grafts were analyzed histologically and radiographically at endpoint. RESULTS: All animals survived to the endpoint with minimal respiratory symptoms and normal growth rates. No complications were observed. Computed tomography scans of the post-surgical airway demonstrated graft patency at all time points. Histological sections showed no sign of stenosis or necrosis with preservation of the native structure of the trachea. CONCLUSION: We established benchmarks for airway replacement. Our findings suggest that a rabbit model of tracheal autograft with direct reimplantation is feasible and does not result in graft stenosis or airway collapse.

Post-Sympathectomy Care in Patients with Incessant Ventricular Tachycardia: A Case Study.

Introduction: Incessant Ventricular Tachycardia is a condition characterized by multiple episodes of Ventricular Tachycardia (VT) in 24 hours, persisting despite efforts to stop the arrhythmia. In this condition, sympathectomy as the surgical procedure is considered a permanent intervention and the last resort when medications prove ineffective. This procedure comprises the cutting or clamping of sympathetic nerves to prevent the transmission of nerve signals. Therefore, this study aims to present a case report of post-sympathectomy nursing management in a patient with Incessant Ventricular Tachycardia. Case Presentation: A 59-year-old female patient was admitted to the high-care unit with a diagnosis of post-sympathectomy, Incessant Ventricular Tachycardia due to Arrhythmogenic Cardiomyopathy. Nursing problems based on NANDA included decreased cardiac output, gas exchange impairment, and activity intolerance. Furthermore, the nursing interventions for the condition included self-care management and collaboration with an anesthesiologist and cardiologist. The interventions encompassed cardiac care, airway management, and activity therapy. Tele-nursing was also conducted through video calls to monitor the patient after hospital care. Results: The planned nursing care was effective in preventing common complications that often occur after the surgical procedure. The most important key aspect is regular maintenance and monitoring. The patient was discharged on the third day after the surgery with no complaints of shortness of breath, palpitations, and gradual resumption of activities. Conclusion: Sympathectomy procedures could successfully be used to treat patients through multidisciplinary collaboration. Furthermore, nurses could emphasize post-operative care management to expedite recovery and improve patient quality of life.

How to undertake a pain assessment for -patients with acute post-operative pain.

RATIONALE AND KEY POINTS: Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient's recovery and increase their risk of developing chronic pain. •  Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •  The assessment process for patients with acute pain is fundamental to understanding the patient's current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •  Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. REFLECTIVE ACTIVITY: 'How to' articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •  How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •  How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain.

Excision of a Giant Cell Tumor With Bone Grafting and Bone Cementing of the Proximal Humerus: A Case Report.

Giant cell tumors (GCTs) of the bone are uncommon neoplasms that predominantly affect the metaphysis of long bones, with proximal humerus involvement being less frequent. We present the case of a 58-year-old male who presented with a two-month history of progressive right shoulder pain and difficulty in raising his arm. Clinical examination revealed a palpable swelling on the lateral aspect of the right arm. Radiological investigations, including X-ray and magnetic resonance imaging (MRI), confirmed the presence of a primary osseous neoplasm involving the proximal humerus, suggestive of a GCT. The patient underwent surgical excision of the tumor with bone grafting and bone cementing of the proximal humerus. Post-operative care included prescribed medications and physiotherapy. This case highlights the successful management of GCTs of the proximal humerus through a multidisciplinary approach, emphasizing the importance of meticulous surgical technique, appropriate reconstruction, and comprehensive post-operative care for optimal patient outcomes.

Trends in Nutrition-Related Risk Factors Identified Post-Operatively in Patients Treated for a Lower-Extremity Injury.

This study investigated trends within a custom Sports Nutrition Assessment for Consultation (SNAC) survey designed to identify nutrition-related risk factors among post-operative lower-extremity youth athletes. Athletes aged 8-18 years who completed the SNAC at a sports medicine institution after lower-extremity surgery were reviewed for associations between SNAC questions and age/sex differences. Of 477 patients (15.0 ± 2.0 years; 47.8% female), 319 (66.9%) answered 'yes' to at least one question and were identified for a consult, though 216 (64.3%) declined. The most frequent questions to prompt a consult were a desire to better understand nutrition for recovery (41.5%) and regularly skipping at least one meal a day (29.8%). Inter-question responses were often significantly related, especially regarding appetite changes, weight changes, and/or meal-skipping. While consult acceptance was not significantly different between sex/age, males were more likely to report a desire to better understand nutrition (p = 0.004) and a weight change (p = 0.019), and females were more likely to report struggling with dizziness/fatigue (p < 0.001). Additionally, older athletes reported an appetite change (p = 0.022), meal-skipping (p = 0.002), a desire to better understand nutrition (p < 0.001), a weight change (p < 0.001), and an effort/recommendation to change their body composition/weight (p = 0.005). These findings demonstrate a link between risky nutrition behaviors and physical detriments.

Experiences of middle-aged individuals with lower extremity amputation caused by diabetic foot ulcer after disability in China: A qualitative study.

AIM: To understand the experiences of individuals who undergo LEA due to DFU after disability. DESIGN: A descriptive research design in qualitative research. METHODS: Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. RESULTS: Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population.

INTRODUCTION: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. METHODS: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. RESULTS: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. CONCLUSION: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Mouse Anesthesia and Analgesia.

Providing anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. This practice is necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging, for instance), and providing intra- and post-procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical guidance for the investigator, covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, considerations for administering preventative analgesia, and considerations for post-operative care. © 2024 Wiley Periodicals LLC. Basic Protocol 1: Injectable anesthesia Basic Protocol 2: Inhalant anesthesia Basic Protocol 3: Assessing pain.

Impact of sex on the outcomes of deceased donor liver transplantation.

BACKGROUND: Data examining the impact of sex on liver transplant (LT) outcomes are limited. It is clear that further research into sex-related differences in transplant patients is necessary to identify areas for improvement. Elucidation of these differences may help to identify specific areas of focus to improve on the organ matching process, as well as the peri- and post-operative care of these patients. AIM: To utilize data from a high-volume Eurotransplant center to compare characteristics of male and female patients undergoing liver transplant and assess asso ciation between sex-specific variables with short- and long-term post-transplant outcomes. METHODS: A retrospective review of the University of Essen's transplant database was performed with collection of baseline patient characteristics, transplant-related data, and short-term outcomes. Comparisons of these data were made with Shapiro-Wilk, Mann-Whitney U, χ2 and Bonferroni tests applied where app ropriate. A P value of < 0.05 was accepted as statistically significant. RESULTS: Of the total 779 LT recipients, 261 (33.5%) were female. Female patients suffered higher incidences of acute liver failure and lower incidences of alcohol-related or viremic liver disease (P = 0.001). Female patients were more likely to have received an organ from a female donor with a higher donor risk index score, and as a high urgency offer (all P < 0.05). Baseline characteristics of male and female recipients were also significantly different. In multivariate hazard regression analysis, recipient lab-Model for End-Stage Liver Disease score and donor cause of death were associated with long-term outcomes in females. Pre-operative diagnosis of hepatocellular carcinoma, age at time of listing, duration of surgery, and units transfused during surgery, were associated with long-term outcomes in males. Severity of complications was associated with long-term outcomes in both groups. Overall survival was similar in both males and females; however, when stratified by age, females < 50 years of age had the best survival. CONCLUSION: Female and male LT recipients have different baseline and transplant-related characteristics, with sex-specific variables which are associated with long-term outcomes. Female recipients < 50 years of age demonstrated the best long-term outcomes. Pre- and post-transplant practices should be individualized based on sex-specific variables to optimize long-term outcomes.

Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial.

BACKGROUND: Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. OBJECTIVE: Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). METHODS: A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. RESULTS: This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. CONCLUSIONS: Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. TRIAL REGISTRATION: ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52882.

Therapeutic efficacy of platelet-rich fibrin on surgical site wound healing in patients undergoing oral carcinoma resection: A meta-analysis.

Oral carcinoma, a prevalent malignancy of the oral cavity, often results in surgical site wounds post-resection. The therapeutic efficacy of platelet-rich fibrin (PRF) in wound healing and scar formation has garnered significant attention. This meta-analysis aimed to evaluate the role of PRF in promoting surgical site wound healing and reducing scar formation following oral carcinoma resection. A systematic search, adhering to PRISMA guidelines, was conducted across multiple databases. The primary outcomes assessed were the Landry, Turnbull and Howley (LTH) wound healing index and the Manchester scar scale (MSS). Statistical evaluations were performed using RevMan 5.4 software. Six studies were incorporated, involving 93 patients treated with PRF and 97 in the control group. For the LTH index, significant improvements in wound healing were observed in the PRF group with I2 = 74%, (Random: SMD: 3.70, 95% CIs: 2.66 to 4.75, p < 0.01). The Manchester scar scale assessment, which included 60 PRF-treated patients and 60 controls, indicated a significant reduction in scar formation in the PRF group I2 = 79%, (Random: SMD: 9.13, 95% CIs: 6.06 to 12.20, p < 0.01). PRF demonstrates promising therapeutic potential in enhancing surgical site wound healing and reducing scar formation post oral carcinoma resection. The application of PRF has been associated with improved wound healing metrics and diminished scar severity. However, further high-quality studies are warranted to confirm these findings.

Effects of virtual exercise on cardio-pulmonary performance and depression in cardiac rehabilitation phase I: A randomized control trial.

BACKGROUND: Cardiac rehabilitation is recommended for patients undergoing open-heart surgery (OHS). During the hospital admission, these patients suffer from reduced cardiopulmonary performance and decreased psychological health, leading to poor physical function, depression, and morbidity. To prevent post-operative pulmonary complications, a pre and post-operative physical therapy intervention is recommended for patients undergoing heart surgery. Virtual reality (VR) promotes the health status of healthy individuals and those with health conditions. However, few studies have reported the beneficial effects of VR exercise programs on the pulmonary performance and mental health status of patients undergoing OHS. OBJECTIVES: To determine whether by using training enhanced by VR, patients who have undergone OHS can more effectively attain cardiopulmonary performance and improve depression than through conventional physical therapy. METHOD: 60 participants were randomly assigned to a conventional physical therapy and VR exercise program. Each session was conducted once daily until discharge from the hospital. Cardiorespiratory performance and depression were evaluated before surgery and at the time of discharge from the hospital. A two-way mixed ANOVA was performed to compare within (i.e., pre and post-operation) and between (i.e., VR and conventional physical therapy) groups. RESULTS: No significant cardiopulmonary performance gains were detected in patients receiving the VR exercise program when compared with those who participated in conventional physical therapy prior to post-operative OHS (p > 0.05). However, the conventional physical therapy group showed significantly higher depression scores than the VR group (∆4.00 ± 0.98 vs. ∆1.68 ± 0.92). However, cardiopulmonary performance did not differ in both VR exercise and conventional physical therapy.

Managing post-operative stroke following cardiac surgery.

Stroke is a complication that can occur in patients who have undergone cardiac surgery and can lead to life-threatening consequences. The causes of post-operative stroke following cardiac surgery are varied, and it is essential to identify patients who are at risk to support early recognition and effective management. Nurses caring for patients following cardiac surgery should understand the causes of stroke, risk factors, preventive measures, early recognition and treatment. A multidisciplinary approach is crucial in ensuring effective therapeutic interventions and optimising outcomes for patients who have experienced stroke following cardiac surgery.

Utilizing the visual analogue scale (VAS) to monitor and manage pain in post-operative skin wounds after thoracic surgery.

Due to the global increase in thoracic interventions, there is greater emphasis on refining post-operative care. The purpose of this study was to validate the visual analogue scale (VAS) as the valid method for measuring post-operative pain in thoracic surgery patients. From January 2020 to June 2022, this cross-sectional study investigated 240 adult patients who underwent elective thoracic surgeries in Thoracic Surgery Department of Heilongjiang Provincial Hospital. The participants were instructed to rate their discomfort using VAS at predetermined intervals after surgery. The following demographic and clinical information was recorded: age, gender, type of thoracic surgery, and history of chronic pain. Results showed a progressive decline in post-operative VAS scores over 72 h: 8.2 immediately after surgery, 6.0 at 24 h, 5.4 at 48 h, and 3.6 by 72 h. There were notable correlations between VAS scores and chronic pain history, with moderately positive correlation of 0.40 being observed. Mean scores for males and females were 3.8 and 3.9, respectively. The analysis by age revealed comparable mean scores for age categories below and above 40. With the exception of thoracic wall resection, which resulted in an average VAS score of 4.1 ± 1.0 (p < 0.05), the type of surgery had the minimal effect on variability of pain scores. The VAS is a reliable method for evaluating post-thoracic surgery discomfort. Given the substantial impact of pain history on VAS scores, there is an urgent need for personalized pain management strategies to improve post-operative care.

Craniopagus: a proposed nursing care protocol.

Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the nursing teams involved. A multidisciplinary group of professionals in a tertiary paediatric care setting in Italy developed a comprehensive protocol for the nursing care of craniopagus twins in hospital, informed by the findings of a literature review and the expertise of its members. The protocol was applied to the management of a pair of craniopagus twins who successfully underwent separation surgery at the authors' hospital. The protocol describes the crucial role of nurses in the care of craniopagus twins and their families before, during and after separation surgery.

Managing common neurological complications following cardiac surgery.

Despite recent technological advances in the field of surgery, neurological complications remain a significant post-operative issue. Two of the most common post-operative complications are delirium and post-operative cognitive decline, which occur frequently after cardiac surgery. This article provides an overview of delirium and post-operative cognitive decline, including risk factors, signs and symptoms, and diagnosis. The author also considers the nurse's role in managing patients who are at risk of, or have experienced, delirium or post-operative cognitive decline after cardiac surgery.