Peri-operative management of frailty in the orthopedic patient.

The purpose of this investigation was to summarize current research on diagnosis, outcomes, and management of frail patients undergoing orthopedic surgery. Because frail patients are at increased risk of negative post-operative outcomes including increased 30-day mortality and post-operative complications including infections and delirium, such a review is timely. Strategies including supervised exercise training programs before surgery, early identification of frailty, prophylactic antibiotics, regular drug chart review, regular monitoring of electrolytes, and other strategies to prevent post-operative delirium are helpful in the management of frail orthopedic patients. It is important for surgeons and anesthesiologists to take action in attempt to alleviate adverse post-operative outcomes in frail patients. Ultimately, more research is needed to identify new strategies and to evaluate whether pre-operative optimization can effectively mitigate post-operative outcomes in large-scale randomized controlled trials.

An evaluation of preoperative anxiety in Spanish-speaking and Latino children in the United States.

BACKGROUND: There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included. AIMS: The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric preoperative anxiety. METHODS: Participants were 294 children aged 2-15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia. Participants were recruited and categorized into 3 groups: English-speaking non-Latino White (n = 139), English-speaking Latino (n = 88), and Spanish-speaking Latino (n = 67). Children's anxiety was rated at 2 time points before surgery: the time the child entered the threshold of the operating room (Induction 1) and the time when the anesthesia mask was placed (Induction 2). RESULTS: Results from separate linear regression models at Induction 1 and Induction 2, respectively, showed that being from a Spanish-speaking Latino family was associated with higher levels of preoperative anxiety compared with being from an English-speaking family. In addition, young age and low sociability was associated with higher preoperative anxiety in children. CONCLUSION: Clinicians should be aware that younger, less sociable children of Spanish-speaking Latino parents are at higher risk of developing preoperative anxiety and manage these children based on this increased risk.

Effect of full-fat soy paste and textured soy granules on quality and shelf-life of goat meat nuggets in frozen storage.

Goat meat nuggets were prepared using commercially available textured soy granules and reduced beany flavour full-fat soy paste (FFSP) made by simple processing technology to compare the performance of these proteins in a comminuted meat system. Addition of soy proteins (soy paste and soy granules) did not significantly affect the product yield, pH, moisture and fat percentage whereas protein content and water holding capacity (% expressible water) were significantly (p>0.05) lower in nuggets with 15% soy paste. Lower force was required to compress or shear the sample as hardness, springiness, gumminess and chewiness decreased in soy paste incorporated nuggets. Soy proteins either paste or granules, did not affect sensory attributes except flavour and overall acceptability. Nuggets with soy paste and control ones did not differ significantly for flavour and overall acceptability whereas nuggets with soy granules were rated significantly (p>0.05) lower. The nuggets remained stable with minor changes in physico-chemical, microbiological and sensory quality during frozen storage (-18±1°C) for 90days. It is concluded from this study that FFSP could be successfully incorporated in comminuted meat systems for producing quality products similar to commercially available soy granules.