A prospective study of nurse and patient education on compliance with sequential compression devices.

Sequential compression devices (SCD) have become the most common form of prophylaxis against the formation of deep venous thrombosis (DVT) among surgical patients. However, compliance with SCD has traditionally been poor. The aim of this study was to assess the affect of patient and nurse education by surgeons on SCD compliance. This was a prospective study involving a single teaching hospital. Compliance was checked twice daily. The main outcomes were compliance rates with SCD use before and after nurse and patient education. Nurses were not aware of the study. Surgical floors had a history of resident and attending interactions regarding SCD, whereas nonsurgical floors did not. A handout that emphasized SCD importance was also given to patients on surgical units. Before education, surgical units had a compliance rate of 61.5 per cent, whereas nonsurgical units had a 48 per cent compliance rate. This difference was significant (P = 0.014). After nursing and patient education on the busiest surgical floor, compliance rates on the surgical ward increased to 65 per cent, a difference that was not of statistical significance (P = 0.515). A nursing unit's daily experience is the most important factor in their compliance rates with SCD use. Focused nursing lectures and patient education may have incremental value.

Use of decellularized human skin to repair esophageal anastomotic leak in humans.

Multiple surgical techniques have been described for repair of esophageal leaks. None of the repairs are optimal, and the morbidity and mortality of an esophageal leak remains high. To our knowledge, this is the first case report of use of AlloDerm (Lifecell Corp, Brachburg, NJ) to successfully repair a thoracic anastomotic esophageal leak.

Disability and chronic pain after open mesh and laparoscopic inguinal hernia repair.

Proponents of laparoscopic inguinal hernia repair maintain that the associated costs and risks are offset by faster recovery and less postoperative pain. It was our hypothesis that the incidence of chronic pain in both groups of our patients was not as high as reported in the literature. Patients for the study were identified from a community hospital medical record database. A total of 229 patients were available and agreed to participate in the study. Data collected included the patient's current pain level at the hernia site, pain medication currently used, narcotics currently used, return to normal work, and return to normal activity. Overall, 19.7 per cent of patients complained of mild pain, but only 2.2 per cent classified this as moderate or severe. Mild pain was noted more often in the open repair patients compared with the laparoscopic group. However, there was no difference in the frequency of moderate or severe pain. The time to return to work was longer in the open repair group than the laparoscopic repair group, but there were large ranges in both groups. The inability to return to full preoperative activity was infrequent and equivalent in both open and laparoscopic hernia repair groups. In our study of 229 patients undergoing elective open or laparoscopic inguinal hernia repair at a community hospital, we have found a low incidence of moderate or severe chronic pain. In addition, we found that this procedure did not interfere with return to work at 6 months or return to daily activities in either the laparoscopic or open repair group.