جستجوی مقالات مرتبط با کلیدواژه "مراقبت پس از عمل" در نشریات گروه "پزشکی"

Enhanced recovery after surgery (ERAS) is now firmly established as a global surgical quality improvement initiative that results in both clinical improvements and cost benefits to the healthcare system. ERAS guidelines are based on the highest quality evidence available and as such require updating on a regular basis. The ERAS Gynecologic/Oncology guidelines were first published in February 2016. This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.1,2

Starting from the original ERAS Gynecologic/Oncology guidelines, the first author and senior authors identified topics for inclusion. International authors known for their expertise in gynecologic/oncology perioperative care were invited to participate in the guideline update. A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with an emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system,3 whereby recommendations are given as follows: Strong recommendations: The panel is confident that the desirable effects of adherence to a recommendation outweigh the undesirable effects, weak recommendations: The desirable effects of adherence to a recommendation probably outweigh the undesirable effects, but the panel is less confident.

The evidence base, recommendations, evidence level, and recommendation grade are provided for each individual ERAS item below. The table 1 shows all the ERAS items with emphasis on changes for the 2019 guideline update. The (Table 2) shows items: (pre-operative optimization, pre-anesthetic medication, nausea and vomiting prophylaxis, urinary drainage, and early mobilization). These items not updated in 2019 guideline (no change in recommendation/evidence. All recommendations on ERAS protocol items are based on the best available evidence. The level of evidence for each item is presented accordingly.

The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

The aim of this research is to determine the effect of applying FOCUSPDCA strategic program of the pre-operative care process on hemodynamic status of caesarean women.

this is a quasi-experimental study conducted in 2016, in one of  Dorud-Iran hospitals. Samples were selected using objective-based random method. Samples (n=70) were divided into the test and control groups. Data collection instruments was pressure gauge and a watch. Validity and reliability of the questionnaire was assessed and confirmed. At first, hemodynamic parameters including pulse rate, systolic and diastolic blood pressure were measured in control group three times: the night before surgery, the moment of entering the operation room, and after surgery in recovery room. After sampling in control group, the FOCUSPDCA strategic program was implemented. The program consisted of nine steps. They were implemented one after another. Then, the test group was selected and the memberschr(chr('39')39chr('39')) hemodynamic parameters were measured. The SPSS-17 was used for data analysis.

The mean systolic blood pressures were 113.17 and 91.14 before and after operation in control group, respectively; while they were 115.14 and 107.71 in the test group. Moreover, the mean diastolic pressures were 69.43 and 59.43 before and after operation in the control group, respectively, while they were 65.43 and 62.14 in the test group. The variance analysis test revealed a meaningful statistical difference between the mean systolic and diastolic blood pressures among the two groups. The control group experiences drop in blood pressure, while the test group faces no considerable drop in blood pressure. The average of heart rates in the control group were 13.91 and 104.71 before and after operation; while they were 80.26 and 79.1 in the test group. The variance analysis test revealed a significant statistical difference between the two groupschr(chr('39')39chr('39')) heart rate (p<0.001). Heart rate reduced in test group.

According to the result of the study hemodynamic situatin has been improve in the test group. Therfore, it is suggested that the program to be implement .in order to improve the health care process in the hospital.

Fasting before surgery is a necessity, but prolonged fasting can lead to serious complications such as decreased perfusion and organ dysfunction. Considering the importance of normal renal function in surgery, the aim of this study was to determine the relationship between fasting duration before urological surgery and postoperative renal function.

This cross-sectional study was done on 105 patients under urological surgeries. Samples were selected using available target-based method. For each patient, the fasting duration were completed. To measure kidney function before and 24 hours after surgery, serum levels of creatinine (Cr), urea, and blood urea nitrogen (BUN) were determined. Data were analyzed using, paired t test and Pearson correlation coefficient via SPSS software.

In this study, 105 patients participated who were candidates for urological surgery with a mean age of 52.30 ± 17.06 years. The mean preoperative fasting duration was 15.22 ± 3.70 hours. There was a significant increase in the amounts of serum Cr, BUN, and urea levels after surgery. There was a significant positive relationship between fasting duration and serum Cr, BUN, and urea levels after surgery.

According to the results of this study, there is a relationship between prolonged fasting and renal function. Therefore, special attention of health care providers on the strict implementation of preoperative fasting standards can lead to improved postoperative patient outcomes.

Experience profile: Nargis Hospital (specialized), has 33 beds Describe the need for a change to be detected (description of the current situation is problematic):Find the first step and find the problem
1- Transferring women under cesarean section to the operating room should be carried out by a professional (nurse) who was provided by the service. That information was not given accurately and there was a risk to the patient.
Preoperative training is not about what awaits women under cesarean section (patient). Which caused women's fear and anxiety and increased blood pressure.
3. Before the operation, patients did not receive serum and usually suffered from hemodynamic instability, which was caused by reduced volume of fluids and electrolytes. The collection took about 8 days. The goal of the change: to enhance the strategy of the preoperative care process using the FOCUSPDCA method

Long-term fasting before surgery can lead to serious post-operative complications. The aim of this study was to evaluate pre-operative fasting in elderly people and its subsequent implications. This is a cross-sectional study that was carried out from March 2009 to March 2009 in the educational hospitals of Iran University. 151 elderly, who were candidate for surgery, participated in this study. The data gathering tool was a researcher-made checklist which its validity was obtained through content validity and its reliability was obtained through calculation of the correlation of the evaluators’ assessment scores. Data were analyzed using spss21 software. The findings showed that, 69 (45.7%) of participants were men and 82 (54.3%) were women, 51% had cardiovascular disease. The mean overall duration of fasting was 11.7 ± 2.79. Only 30 of them experienced a 6-8 hours fasting period, while 19 patients experienced 10-8 hours, 46 patients were NPO (Nothing by mouth )for 10-12 hours, and 56 were more than 12 hours NPO before surgery. Based on the results of this study, it seems that preoperative care in elderly people, especially about duration of NPO time and attention to assessment of vital sign and Comorbidities, is not sufficiently precise. Therefore, it is recommended that caregivers receive adequate education about preoperative care

: Nurses are the largest group among the health professionals and both legally and ethically they must be responsible for the quality of the cares provided. And, one of the major aspects of the quality of care is the standard. This study aims at investigating the barriers in implementing the nursing standards in caring for the patients after an abdominal surgery is done.
This is a descriptive cross-sectional study. The target population of the study, that were selected through the simple sampling method, are all the nurses working at the abdominal surgery wards of training-clinical hospitals of Kermanshah. To gather the required data, a self-made questionnaire on individual, administrative, and environmental barriers to fulfilling standards in caring for the patients after abdominal surgery. Its validity through content validity and its reliability via test-retest method and the alpha 0.80 were confirmed. SPSS software version 16 was used for the analysis of data.
The findings from 30 participants, whom 43% of which were female, showed that the greatest barriers to the implementation of standards were: 46.7% for the lack of motivation (as an individual barrier), 73% for the lack of standardized evaluation (as an administrative barrier), and 76.7% for routine-orientedness (as an environmental barrier)
The findings from 30 participants, whom 43% of which were female, showed that the greatest barriers to the implementation of standards were: 46.7% for the lack of motivation (as an individual barrier), 73% for the lack of standardized evaluation (as an administrative barrier), and 76.7% for routine-orientedness (as an environmental barrier)

Patient satisfaction is an important concept and priority in health system. The aim of this study was to assess patient's satisfaction from nursing care in hospitals of Iran University of Medical Sciences.

In this cross-sectional study, 450 patients who had undergone surgery during six months were selected to the study. Data were collected using a self-structured questionnaire. Patient's satisfaction was measured in a 5-point Likert scale.

The overall satisfaction of patients pre- and post operation was at an optimum level of 83.6% and 89.1%, respectively. The mean overall satisfaction with nursing care was not statistically significant before and after the surgery. Patient's satisfaction after the surgery was significantly related to the education, gender and residential area (p<0.05).

Most patients were satisfied with the nursing care before and after the surgery. Patient satisfaction should be measured at the time of discharge as an evaluation index.

Fasting following abdominal surgery is a traditional surgical practice based on fears of causing postoperative complications if oral intake begins before bowel function returns. However, supporting scientific evidence for this traditional practice is lacking and there are potential benefits from early postoperative of oral intake compared with parenteral nutrition. The aim of this study was to assess the safety, tolerability, and outcome of early oral feeding after elective colon anastomosis.

All patients who underwent elective colon anastomosis between 2009 – 2011were randomized to one of the following two groups: Group one: early oral feeding, patients received a clear liquid diet on the first postoperative day followed by a regular diet. Group two: feeding (delay) only after the resolution of their postoperative ileus. The patients were monitored for vomiting, bowel movements, time of regular diet consumption, complications, amount of serum received, and length of hospitalization.

Seventy-eight patients were studied, 38 patients in group one and 40 patients in group two. There were significant differences between the early and regular feeding groups in the overall complications and significant reduction of length of hospitalization, serum reception, postoperative ileus, vomiting, and abdominal distension, time of presence of flatus, postoperative nasogastric tube placement, morbidity, wound complications, and pneumonia in group one.

Early oral feeding is safe and can be tolerated by patients. Reduced length of ileus and shorter hospitalization may occur with multimodal protocols. Thus, it may become a routine feature of postoperative management in these patients. Further studies should focus on the cost effectiveness, patient's satisfaction, and other physiological changes.

Abdominal operations as gynaecological procedures result in gastrointestinal dysmotility. Early feeding and ambulation are nonpharmacologic interventions which can be useful in re-initiation of bowel function. This study was done to evaluate the effect of early oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women. In this randomized clinical trial, 120 primiparous women undergone elective cesarean section were assigned to control and intervention groups in Hajar hospital, Shahrekord, Iran during 2007. In the interventional group, oral hydration with liquids was started 4 hours after surgery regardless of presence of bowel sounds and solid food was started after bowel sounds appeared. The control group recieved liquid diet 12 hours after the operation if it was tolerated, they were given soft diet and regular food at the next meal. The return of bowel activity, time of ambulating, satisfaction, discharge from the hospital and complications were compared in two groups. The data were analyzed using SPSS-15, Chi-Square, T and one way ANOVA tests. The mean postoperative time interval to first hearing of normal intestinal sounds in interventional versus control groups were (9.5±1.38 and 12.5±2.5 hours) the first passage of flatus (15.7±3.61 vs.22.4±4.1 hours), time to first sensation of bowel movement (10.8±1.99 versus 15.7±3.4 hours) and defecation (18.9±3.65 versus 23.4±4.85 hours). These differences were significant (P<0.05). Also discharge from the hospital (0.96±0.18 versus 1.1±34 days) were significantly shorter in interventional group (P<0.05). The women in the early feeding group got out of bed (patient mobilisation) earlier than their interventional group (14.1 hours versus 18.8 hours (P<0.05). Maternal satisfaction was significantly higher among the early fed women (P<0.05). Early oral hydration after elective cesarean section associated with rapid resumption of intestinal motility and increased woman’s satisfaction.

Postoperative ileus is common after cholecystectomy, causes gas retension, distention, nausea, vomiting, and even pain. Chewing gum is a type of sham feeding that may reduce the duration of postoperative ileus. This study determines the effect of chewing gum in the immediate postoperative period to facilitate ileus recovery following cholecystectomy. This is a randomized controlled trial in 2009. Twenty-four patients undergoing cholecystectomy and they divided in to two equal groups (n=12). Patients in group A chewed sugarless gum there time after surgery, each time 20 miniutes in 4, 10 and 18 hours after finishing sugery. Demographics, intraoperative, and postoperative care data did not reveal any significant difference between two groups. The data resending the first passage of flatus, defecation and bowel sound in every 2 hours for each patient completed in questioning. Data were analyzed using SPSS software version-13.5 and student t-test. The first bowel sound heard 3 ±1.3 and 2.8 ±1.3 hours post-operatively in cases and controls, respectively. The above findings were not significant between two groups. Furthermore gas passing reported at 18.3±10.5 and 36.28±12.6 hours post-operation in case and control groups respectively. The first defecation was occured at 36.8 ±21.7 and 69.5 ±19.2 hours after operation in case and control groups, respectively (p =0.001). This study showed that the chewing gum can help bowel movement after cholecystectomy.

Postoperative ileus after appendectomy causes gas storage, distention, nausea, vomiting, and even pain. Gum chewing is one of the ways that can reduce the duration of temporary ileus. The aim of this study is to determine the effect of gum chewing on bowel movements following appendectomy. This randomized double-blind clinical trial was done on 46 patients undergoing appendectomy that were divided into equal treatment and control groups. The treatment group chewed gum three times, each time for 20 minutes, 4, 10, and 18 hours after recovery from anesthesia. The control group, however, did not receive any special treatments. The bowel sounds were monitored every two hours using stethoscope. Also, through running interviews with two hour intervals, data were collected regarding the first passage of flatus and defecation. Data were analyzed through SPSS and t-test. On average, the first bowel sounds in treatment and control groups were, respectively, heard at 2.08±0.41 and 3.13±1.45 hours, whereas gas passage in treatment and control groups was reported at 26.8±14.59 and 50.08±13.92 hours, respectively. Also, the first defecation in the treatment group occurred at 18.91±10.77 hour but in the control group this happened at 29.21±12.11 hour. Based on these observations, a significant difference was seen between the two groups in terms of the test results (p=0.002). The findings of this study showed that chewing gum can help bowel movements after appendectomy.

Previous studies have shown that early postoperative colon anastomosis oral feeding is feasible. Traditionally patients were fed when flatus or defecation documented the return of bowel function. All patients who underwent elective laparotomy with colon resection and anastomosis between December 2006 –and December 2007 were prospectively randomized to one of the following two groups: group 1: early oral feeding--all patients received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated; group 2: regular feeding--all patients were treated in the "traditional" way, with feeding only after the resolution of their postoperative ileus. The patients were monitored for vomiting, bowel movements, time of regular diet consumption, complications, amount of serum received and length of hospitalization. A total of 64 consecutive patients were studied, 32 patients in group 1 and 32 patients in group 2. There were no significant differences between the early and regular feeding groups in the overall complications or mortality, but there were significant reduction of length of hospitalization and serum reception in the early oral feeding group.Early oral feeding after elective colon surgery is safe and can be tolerated by the patients. Thus, it may become a routine feature of postoperative management in these patients.

Although anesthesia and surgery have become safer and more successful than ever before, preoperative anxiety is still a common problem. In this study, we translated and validated the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for Iranian population.

We first translated the English version into Farsi, then translated back into English. The translation to English was authorized by the correspondent author of English version (Tim Wysocki).The questionnaires were completed by 130 patients with A.S.A I and II scheduled for elective outpatient surgeries. They also completed 20-item Spielberger’s State Anxiety Inventory (STAI-State) questionnaire concurrently as a gold standard for evaluation of preoperative state anxiety.

Cronbach’s alpha was 0.84 for the anxiety scale and 0.82 for the need-for-information scale. The correlation between the anxiety items of the APAIS and the STAI-State was high (0.68) and the correlation between the information items and the STAI-State were intermediate (0.50). Factor analysis with oblique rotation revealed two factors which explained 72% of the total variance: anxiety and need-for-information. Female sex and need-for-information were independently associated with preoperative anxiety. Anxiety was significantly higher in females (9.30±4.12) than males (5.8±2.30) (P<0.001). Assuming APIAS for anxiety equal or more than 11 as cut-off point, 21% of our study patients were anxious and 68% of our patients had a positive-information attitude.

Farsi version of APAIS is a valid and reliable instrument for evaluation of preoperative anxiety and information requirement. Gender and information requirement are independently associated with preoperative anxiety. .

Normal transition to a parenthood stage would be critically superimposed by birth of an infant with Congenital Heart Disease (CHD). Providing some information about how to take care of the baby with CHD and heart surgeries and also supporting the mother will decrease maternal stress and consequently improves infant’s health. to investigate the learning needs of the mothers of infants with heart surgeries regarding post operative care in the health centers in Tehran, 1384. the design was a descriptive study in which a questionnaire was as a data gathering instrument.Sixty-two mothers of the infants with congenital heart diseases with continuous sampling method participanted in this study.The study findings showed that 14.5%, 66.1% and 19.4% of mothers had low, moderate and high levels of learning needs respectively. There were not any significant relationships between learning needs and any other variables age or educational levels. According to the results of the study, providing information to meet the learning needs of mothers would eventually, decrease mother their stress to look after the babies in a better way. Soit seems that, providing educational classes based on the mother's learning needs would be necessary in the setting of children's hospitals with heart surgeries wards. It is recommended that, needs assessment of the mothers of infants with heart surgeries, after discharge, would be necessary for future studies.