جستجوی مقالات مرتبط با کلیدواژه « Postoperative Care » در نشریات گروه « پزشکی »

In this article, proving fault in medical accidents, by emphasizing the expansion of the concept and scope of fault and providing solutions for the presumed fault of the physician, and explaining the types of fault in different stages of treatment, with the aim of using the experience of French legislation and jurisprudence our country has been examined.

The research method is descriptive-analytical and the data collection method is library, with emphasis on the interpretation of judgments and legal texts and the analysis of the views of lawyers.

In this research, the principles of fidelity, honesty, impartiality and originality of the research have been observed.

French jurisprudence has used various legal tools to develop the concept of medical fault and facilitate its proof; this should be taken into consideration by our courts as well.

French jurisprudence provides a broad concept and scope of medical malpractice and any fault on the part of a physician or health center, however simple and any misrepresentation of scientific information or medical conscience has been held liable and effective measures have been taken to facilitate proof. Also, the types and examples of faults in different stages of diagnosis, selection of treatment, medical practice and supervision, have been well separated and regulated by the doctrine and judicial procedure of this country and using personal responsibility and responsibility arising from other acts for the surgeon and Anesthesiologists and the admitting presumed faults and the like, have sought to facilitate the Compensation of victims of medical accidents; this is also suggested by the Iranian judicial procedure.Please cite this article as:Karimi A, Javaherkalam MH. Proof of Fault in Medical Accidents in French Law. Medical Law Journal. 2022; 16(57): e18.

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.

About 3% of neonates have large physical disorders that need surgeries. Upon increase in birth of premature neonates, the disorders that need surgeries have increased.esophagial atresia, bowel obstruction and imperforated anus are among the common disorders of neonates that can be dealt more effectively and safer with nursing cares according to the existing standards and the duration of stay of neonates at hospitals shall be decreased. This study aims to evaluate the compatibility of pre and Postoperative nursing cares with the existing standards. The present research is a descriptive auditing study in which 150 cases of nursing cares before and after the neonatal surgical operations have been studies and compared with the existing standards. The data collecting tool was checklist containing the data related to the manner of standard cares before and after neonatal surgical operations, being designed based on the review of existing contexts and standards and its validity and reliability was evaluated by contextual validity study and calculation of ICC (Intraclass Correlation Coefficient), respectively, equivalent to 0.88. The method of information collecting was done by observation and recording the choices of the checklist at NICU (Neonatal Intensive Care Unit) of Mofid and Mahdieh Hospitals, affiliated with Shahid Beheshti University of Medical Sciences. The data were then analyzed with descriptive statistics. The compatibility of pre and Postoperative nursing cares at the neonates’ wards and NICUs was evaluated as medium (66.9%), where 60.7% of the cares were done properly and 12.5% of them were not done properly and 26.8% of the cares were not done. The pre and Postoperative neonatal nursing cares are far away from the standards and it can be attributed to the carelessness of the caretakers, insufficiency at education, and shortage of facilities and equipment.

Tracheostomy is one of the most common surgical procedures performed on the patients with airway obstruction. The outcome and respective complications depend on postoperative orders and care. The complications are very important, common, but preventable. The aim of this study was to evaluate post- tracheostomy care status in Rasht hospitals in 2010 and 2011. This descriptive study was conducted on 96 patients who have undergone tracheostomy in Rasht educational hospitals in 2010-11. Initially, the data consisting of demographic characteristics, tracheostomy tube selection and surgical procedures, postoperative orders and performed orders by nurses (on the bases of observations of researcher) were collected by a questionnaire. Then, they were analyzed by frequency tests on SPSS 17 software. From 96 patients, 77 patients were male (80.2%) and the rest were female (9.8%), and the average age of men was 53.60+ 18.68 and for women 39.50 + 17.77 years. The most common indication of tracheostomy was prolonged intubation (58.9%). Also, 7 cases (7.3%) had complicated tracheostomy. In 78 adult patients, tube was not of adequate standard size (in men: 9 mm and women: 7.5-8 mm), but it was standard in children (6.3% from overall patients). Administration of wet oxygen, antibiotics and using cuffed tubes were standard in all cases, usage of cold steam (83.3%), adequate pressure of cuff (55.20%), hyperventilation before suctioning, (49%) tube size of tracheostomy (15.8%), change of dressing (47.91%) and frequency deflection of tube cuffs (44.78%) were not standard. These results demonstrate that post tracheostomy care in educational hospitals in Rasht was not performed on standard bases, and serious attention on the part of respective authorities is needed.

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.

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.