Cancellation of Surgeries: Integrative Review.

PURPOSE: To analyze cancellations of surgeries and identify evidence-based interventions to address this issue. DESIGN: Integrative literature review. METHODS: An integrative literature search was conducted in four databases: CINAHL, PubMed, Embase, and Cochrane and included literature sources dated January 2011 to January 2016. The complete list of search terms consisted of the following: ambulatory surgery, day surgery center, elective surgical procedure, elective operation, elective surgery, schedule, access to care, surgery cancellation, operation cancellation, and surgery delay. FINDINGS: Twenty-three literature sources were identified. Evidence included one randomized controlled trial and multiple studies. Causes of cancellations were classified into three categories: hospital-related reasons, patient-related reasons, and surgeon-related reasons. Evidence confirmed most cancellations were avoidable. CONCLUSIONS: Cancellation of scheduled surgeries has a significant impact on patients' health, resources, cost, and quality of care. It is difficult to devise a solution without understanding the cause of cancellations.

Elective Surgical Cancellations in a Tertiary Hospital in the Middle East: Quality Improvement Process.

PURPOSE: Cancellation of elective surgery negatively affects patient outcomes and the efficiency of the work environment. The purpose of this project was to analyze the cancellation of elective surgeries and identify the best evidence-based interventions to address cancellations in a tertiary hospital in the Middle East. DESIGN: A quality improvement study design. METHODS: A retrospective review of cancellations conducted over two 3-month periods in 2016 and 2017. FINDINGS: In both phases of the audit, patient-related reasons were the leading cause of cancellations. Conducting a preoperative call 2 days before surgery and doing a weekly review of the surgery schedule reduced cancellations from 3.8% to 3.5%. Cancellations because of patient-related reasons reduced from 81% to 79.7% whereas cancellations because of hospital-related reasons reduced from 17.5% to 15.9%. CONCLUSIONS: Cancellation of surgeries is a worldwide health care issue and without understanding the causes of cancellations, it is difficult to devise an effective intervention to address this issue.

Gastro-oesophageal reflux. Part 2: medical treatment.

INTRODUCTION AND BACKGROUND: Gastro-oesophageal reflux disease (GORD) is a chronic disease characterised by retrograde movement of stomach contents into the oesophagus. It causes heartburn and oesophagitis and adversely affects quality of life. If left untreated it can lead to oesophageal stricture and carcinoma. The prevalence in Western countries is 30%. This paper presents a comparative review of the effectiveness of Omeprazole with Ranitidine for treatment of GORD. METHODS: A search for English language studies on adults was conducted using three databases, MEDLINE, EMBASE and the Cochrane Central Register of RCTs. Thirty relevant studies were included in the review. FINDINGS: Omeprazole is more effective in controlling heartburn symptoms, healing oesophagitis, improving quality of life and preventing relapses than Ranitidine, but takes time to reach therapeutic effect. Ranitidine is more effective at relieving symptoms on an as required basis. CONCLUSIONS: Nurses need to be aware of the effectiveness and use of these medications so that patients can make informed treatment choices and develop a greater understanding of the importance of concordance with prescriptions.

Gastro-oesophageal reflux. Part 1: smoking and alcohol reduction.

INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is defined as an abnormal reflux of the stomach contents into the oesophagus, which provokes symptoms and impairs the quality of life. GORD has a high prevalence and incurs costs to the healthcare system. This is the first paper in a series of three exploring the conservative, medical and surgical treatment of GORD. This first paper presents a review of the effect of smoking and alcohol on reflux symptoms and the impact of smoking and alcohol reduction on symptoms of GORD. METHODS: A search for English language studies on adults was conducted using three databases, MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Eleven relevant studies were included in the review. FINDINGS: The effect of alcohol on the stimulation of reflux has been debated over the years in different studies. Some studies state that alcohol consumption induces reflux and moderate amounts exacerbate nocturnal gastro-oesophageal heartburn reflux. However, other studies have found no association between alcohol consumption and reflux. Most reflux occurs during smoking because nicotine causes the lower oesophageal sphincter to relax, which increases the risk of reflux. Similarly, the number of cigarettes smoked is associated with the risk of reflux. CONCLUSIONS: Nurses need to be aware of the effect of smoking and alcohol on reflux to provide evidence-based advice to empower patients to change their lifestyle, which results in increased therapeutic compliance and a better clinical status. There is no evidence that reducing alcohol consumption decreases symptoms and only limited evidence on the effectiveness of smoking cessation. Further research into the effectiveness of these lifestyle modifications is therefore required.